Premera Adult Optima $50/0%
Dental PPO Network
Embedded Pediatric Dental (In-Network)*
Annual Deductible
Preventive: none
$50 individual/$150 family
Preventive: None
$3,300 individual/$6,600 family
Annual Plan Maximum
$2,000
N/A
Preventive Services
X-Rays
Office/Visits/Exams
Cleanings/Prophylaxis
(Twice per calendar year)
Plan pays 100%
Plan pays 100%
Basic Services
Fillings
Root Canals
Oral Surgery
Periodontics
Endodontics
Plan pays 80%
Plan pays 70%
Major Services
Crowns
Bridges
Prosthetics
Plan pays 50%
Plan pays 50% after deductible is met
Orthodontia Services
(Adults and children)
Not covered
Not covered
*Pediatric dental coverage is included with the Premera medical plan.
Dependents up to age 19 have pediatric dental coverage through the Premera medical plan. All in-network preventive dental is covered in full. Basic Services are covered at 30% (plan pays 70%) and Major Services are covered at 50%.
Once a dependent turns 19, they must enroll in the Premera Adult Optima dental plan. Reach out to the Alliant Advocates to have this enrollment completed after your dependent turns 19.
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