Dental
Making the most of our dental benefits as a member
Call Member Services at 1-800-240-3851 (TTY 711) between 8 a.m. and 8 p.m.
Visit the Dental Plan website to search by location, dentist name or practice name.2
Saint Alphonsus Health Plan Cash Back No Premium 1 (HMO) and Saint Alphonsus Health Plan Cash Back (HMO) include Basic dental coverage.
- Dental procedures covered with Basic dental coverage (last updated 10/01/2024)
All other plans include a combination of Basic and Comprehensive dental coverage, which covers certain restorative and extraction services at 50% coinsurance as well as endodontics and periodontics at 70% coinsurance.
- Dental procedures covered with Basic and Comprehensive dental coverage for HMO members (last updated 10/01/2024)
- Dental procedures covered with Basic and Comprehensive dental coverage for PPO members (last updated 10/01/2024)
There is a $1,000 annual combined benefit maximum.
Dental Silver is a supplemental option and offers enhanced comprehensive services in addition to the preventive and comprehensive dental services included in your health plan. The annual benefit maximum for Dental Silver is $1,500.
Dental procedures covered with a Dental Silver plan for HMO members (last updated 10/01/2024)
Dental procedures covered with a Dental Silver plan for PPO members (last updated 10/01/2024)
Dental Gold is a supplemental option and includes everything in Dental Silver, plus coverage toward crowns, bridges, and dentures. The annual benefit maximum for Dental Gold is $2,000.
Dental procedures covered with a Dental Gold plan for HMO members (last updated 10/01/2024)
Dental procedures covered with a Dental Gold plan for PPO members (last updated 10/01/2024)
Only the Dental Gold supplemental benefit provides 50% coinsurance coverage for dentures.
You can enroll in Dental Silver or Dental Gold when you first join Saint Alphonsus Health Plan, or you can add or make changes to your optional supplemental dental plan during the Annual Enrollment Period from Oct. 15 through Dec. 7 each year.
2024 Plan Year: Dental Silver is available for $21 per month for HMO and PPO members. Dental Gold is available for $41 per month for HMO members, and $49 for PPO members.
2025 Plan Year: Dental Silver is available for $18 per month for HMO members, and $20 per month for PPO members. Dental Gold is available for $41 per month for HMO members, and $49 for PPO members.
Please note that the Optional Supplemental Dental premium is in addition to your monthly plan premium, if applicable, and your Medicare Part B premium.
1The Optional Supplemental Dental Benefit is not available on the 2024 Saint Alphonsus Health Plan Cash Back No Premium 1 (HMO) or 2025 Saint Alphonsus Health Plan Cash Back (HMO) plan.
2PPO plan members who elect the optional dental plan can receive care from dentists in and out of the network. For services received through non-participating providers, members may pay a higher cost share.
Benefits vary by plans. For more details, please refer to your Evidence of Coverage.