Idemnity Dental Plan

Indemnity Dental Plan Options

Option 1 Option 2 Option 3 Option 4
Calendar Year Deductible2
Individual
Family
 
$ 50
$ 150
 
$ 50
$ 150
 
$ 50
$ 150
 
$ 50
$ 150
Calendar Year Maximum $ 2,500 $ 2,500 $ 1,500 $ 1,500
Orthodontic Lifetime Maximum N/A $ 1,500 N/A $ 1,000
Preventative Services
(Routine Exams, Cleaning, X-Rays)
100% 100% 100% 100%
Basic Services
(Restorative, Periodontics, Endodontics, Oral Surgery)
90% 90% 80% 80%
Major Services
(Crowns, Bridges, Dentures)
60% 60% 50% 50%
Orthodontic Services3 N/A 50% N/A 50%




Monthly Rates Option 1 Option 2 Option 3 Option 4
Employee Only $ 39.74 $ 42.63 $ 33.24 $ 36.13
Employee + Spouse $ 81.98 $ 87.95 $ 68.57 $ 74.53
Employee + Child(ren) $ 97.31 $ 104.38 $ 81.38 $ 88.46
Employee + Family $ 150.22 $ 161.14 $ 125.64 $ 136.56




  • 1 Eligible benefits based on Usual and Customary at the 90th percentile of the National Dental Advisory Service (NDAS) guidelines.
  • 2 Deductible is waived for Preventative Services.
  • 3 Only for covered dependent children through age 18. No benefits shall be payable until the employee has completed 12 months of employment.
  • 4 12 month rate guarantee.
  • 5 10 subscribers minimum participation.

Contact Riverstone Capital, LLC.