BlueDental Premium

Comprehensive dental plus an option for orthodontics

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Consider this plan if

You want to offer your employees a step up from basic coverage.

Coverage available for

Individuals
Families

Plan features

Covered Preventive Services*

Oral exams
Prophylaxis (teeth scaling and polishing)
Diagnostic
Topical fluoride application
Radiographs (X-rays/films)

*These covered prevention services are excluded from the benefit maximums.

Covered Basic Services

Sealants
Emergency oral evaluations, palliative treatment
Fillings
Anesthesia
Simple extractions
Endodontics
Periodontics

Covered Major Services

Crowns, inlays or onlays
Dentures (full and partial)
Bridges, replacement of lost, defective bridges
Occlusal guards (treatment of bruxism)
Implants

Orthodontia Services

Orthodontia option available

Plan highlights

Plan is available with or without orthodontia coverage
Provides access to one of the nation's most extensive dental networks
Preventive services are a focus
Coverage offered through a partnership with United Concordia Dental (UCD)
Employers must contribute a minimum of 50% of the cost of each employee's individual premium payment

Premium

Premium+

Employer Contribution: To qualify for group dental plan, the employer must contribute a minimum of 50% toward the individual contract premium payment.
Employer Participation: Coverage for dental programs are only available to groups of three employees or more.
For further details on the coverage, including exclusions, any reductions or limitations and the terms under which the benefit plan may be continued, see your account executive. United Concordia Companies, Inc. is an independent company providing dental benefit administration services and access to provider network for the Blue Cross Blue Shield of North Dakota dental products.
*These covered prevention services are excluded from the benefit maximums.

Available for Group Size

10+

Deductible

Member: $50
Family: $100

Annual Maximum
(per member)

$1,000

Orthodontic Lifetime Maximum

N/A

$1,500

Prophylaxis (cleanings)*

80%

Preventive Exam*

80%

Preventive Diagnostic*

80%

Fluoride*

80%

Palliative Emergency Care*

80%

Radiographs (X-rays/films)*

80%

Sealants

80%

Fillings

80%

Simple Extractions

80%

Anesthesia

80%

Space Maintainers

80%

Surgical Extractions

80%

Endodontics

80%

Periodontics

80%

Crowns & Inlays

50%

Prosthodontics (removable)

50%

Prosthodontics (fixed)

50%

Surgical Implants

50%

Complex Oral Surgery

50%

Oral Maxillofacial Surgery

50%

Occlusal Guard

50%

Additional information

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Fargo (Headquarters)
4510 13th Ave. S.
Fargo, N.D., 58121