Making Healthy Cheaper
Standard
Dental Coverage

   BlueCross & BlueShield of Oklahoma
   Network: DNoA Preferred
   Customer Service: 800 313 5162
   Website: www.bcbsok.com 
   $1,500 per individual, per plan year
   Once reached, Member is responsible for 100% of dental claims for the remainder of the plan year
   $50 per individual, per plan year
   Free, twice per plan year
   Not subject to Deductible
   For Cleaning, Polishing, Bite-Wing X-Rays & Prophylaxis
   20% Co-Insurance after Deductible
   For Fillings, Simple Extractions, Surgical Removal of Teeth & Root Canals
   50% Co-Insurance after Deductible
   For Crowns, Full or Partial Dentures, Bridge Repairs & Occlusal Guards
   50% Co-Insurance
   Not Subject to Deductible
   For Dependent Children up to Age 26 Only
   $1,500 Lifetime Maximum
Current & Former Employee Coverage & Rates for the 2024/25 Plan Year, effective 7/1/2024 through 6/30/2025.
   42.86    Member
   22.64    Child
   36.02    Children
   52.94    Spouse
   75.58    Spouse & Child
   88.96    Spouse & Children