CapDent Plus 1-800-468-0466
Healthplex dental plans for all groups.
This dental plan is a great choice for employers or groups seeking:
- Low out-of-pocket costs
- Flexibility to use out-of-network dentists at any time
- A published schedule of out-of-net reimbursement amounts
In this managed care program, you and your covered family members select a dentist from the CapDent Directory of Participating Providers and receive all treatment from that dentist.
When you require dental care, call your CapDent participating general dentist, identify yourself as a plan member, and make an appointment. The dentist will provide all treatment according to in-network plan benefits.
If you prefer to visit your own dentist and receive out-of-network benefits, you would submit claim forms to Healthplex for reimbursement based on the out-of-network schedule of benefits.
If you require treatment from a specialist, you may use any participating specialist or your own. Work performed by a participating specialist will be charged directly to you at a discount of 25% less than usual and customary fees. If you prefer to visit your own dentist or specialist and receive out-of-network benefits, submit claim forms to Healthplex for reimbursement based on the out-of-network schedule of benefits.
* Discounts are available based on group size and level of employer's contribution.
Plans Underwritten by Dentcare Delivery Systems, Inc. in NY
| Monthly Premium* | |
|---|---|
| Single | $24.00 |
| Two Party | $41.00 |
| Family | $59.00 |
* Discounts are available based on group size and level of employer's contribution.
| CATEGORY | IN-NETWORK* | OUT-OF-NETWORK** |
|---|---|---|
| DIAGNOSTIC & PREVENTIVE SERVICES | ||
| Oral Exam | $0.00 | $16.50 |
| Full Mouth X-rays | $0.00 | $56.00 |
| Periapical 1st Film | $0.00 | $5.00 |
| Panoramic X-ray | $0.00 | $27.50 |
| Cleaning (Polishing), Child/Adult | $0.00 | $27.50 |
| Fluoride Treatment, to Age 16 | $0.00 | $16.50 |
| Emergency Treatment | $0.00 | $22.00 |
| RESTORATIVE | ||
| Sealants, per tooth | $20.00 | $16.50 |
| Silver Amalgam, 1 Surface | $0.00 | $22.00 |
| Silver Amalgam, 2 Surfaces | $0.00 | $33.00 |
| Silver Amalgam, 3 or More Surfaces | $0.00 | $44.00 |
| Composite Filling, 1 Surface | $0.00 | $22.00 |
| Composite Filling, 2 Surfaces | $0.00 | $33.00 |
| Composite Filling, 3 or More Surfaces | $0.00 | $44.00 |
| Pin Retention | $0.00 | $11.00 |
| ORAL SURGERY | ||
| Routine Extraction | $25.001 | $38.50 |
| Surgical Extraction | $50.001 | $50.00 |
| Soft Tissue Impaction | $50.001 | $65.00 |
| Partial Bony Impaction | $75.001 | $100.00 |
| Full Bony Impaction | $100.001 | $135.00 |
| Alveolectomy w/o Extraction, Per Quad | $50.001 | $65.00 |
| ROOT CANAL THERAPY | ||
| Pulp Capping, Direct | $0.001 | $11.00 |
| Pulpotomy | $0.001 | $32.00 |
| Root Canal Therapy - Anterior | $125.001 | $215.00 |
| Root Canal Therapy - Bicupsid | $190.001 | $250.00 |
| Root Canal Therapy - Molar | $335.001 | $300.00 |
| Apicoectomy | $125.001 | $110.00 |
| PERIODONTICS (Over 18 years of age) | ||
| Scaling of Teeth, Full Mouth | $45.001 | $32.00 |
| Gingivectomy, Per Quad | $95.001 | $80.00 |
| Osseous Surgery, Per Quad | $350.001 | $135.00 |
| PROSTHETICS - FIXED, REMOVABLE | ||
| Acrylic with Metal Crown | $150.00 | $160.00 |
| Porcelain Crown | $270.00 | $160.00 |
| Porcelain with Metal Crown | $270.00 | $215.00 |
| Full Cast Crown | $150.00 | $160.00 |
| Porcelain Laminates | $270.00 | $135.00 |
| Stainless Steel Crown | $50.00 | $55.00 |
| Post | $50.00 | $55.00 |
| Recementation, Per Crown | $0.00 | $17.00 |
| Acrylic w/Metal Bridge Crown or Pontic | $150.00 | $160.002 |
| Porcelain w/Metal Bridge Crown or Pontic | $270.00 | $215.002 |
| Full Cast Metal Bridge Crown or Pontic | $150.00 | $160.002 |
| Resin Retainer | $220.00 | $135.002 |
| Recementation, Bridge | $0.00 | $17.00 |
| Full Upper or Lower Denture (Incl. Adjustments) | $295.00 | $275.002 |
| Partial Upper or Lower Denture (Cast Base) | $295.00 | $305.002 |
| Dentures Repair | $25.00-$75.00 | $12.00-$55.00 |
| Office Reline | $50.00 | $40.00 |
| Lab Reline | $95.00 | $82.00 |
| ORTHODONTICS ** | ||
| Case Fee - 24 Months | 75% UCR | $30.00/mo.3 |
* These fees are the most you will pay to your CapDent/CapDent Plus participating general dentist for the services listed.
** These are the amounts that the plan will pay for the services listed.
1 Copayments for these services when rendered by a participating specialist will be 25% less than the dentist's usual fees.
2 Subject to a 12-month waiting period (other than for single crowns).
3 Subject to 24-month waiting period and lifetime maximum of $720.
Plans underwritten by Dentcare Delivery Systems, Inc.
How do I enroll?
Please call our Sales and Marketing Department at 1-800-468-0466, or send us an email at sales@healthplex.com.
How do I receive dental care and benefits?
Call your participating dentist for an appointment after you receive your ID card and identify yourself as a CapDent Plus Plan member. Visits for routine dental care will be scheduled within a few weeks of your initial phone call. If you have a dental emergency, you will be given an appointment within 24 hours. Should you be away from home with a dental problem, you will be reimbursed up to $50 for emergency care only.
Will I be satisfied with the services of my participating dentist?
All dentists in our network are credentialed by Healthplex.
We conduct site visits to ensure all offices are well equipped, adequately staffed and are following proper sterilization techniques.
If you have a problem with your dentist, we will rectify the situation or refund your premium.
What expenses will I have in this plan for general dentistry and specialty care?
When being seen by your assigned primary care dentist, you are responsible for co-payments based on the service rendered. CapDent Plus Schedule of Benefits If you are seen by a non-participating dentist, you will be reimbursed a fixed amount as shown in the Schedule of Benefits.
For other questions about the plan, please call our Sales and Marketing Department at 1-800-468-0466, or send us an email at sales@healthplex.com.