Horizon Dental Choice Plan A
The Horizon Dental Choice Plan typically covers 100 percent of all eligible preventive and basic services with no copayments, maximums or deductibles when receiving those services from your primary Horizon Dental Choice dentist. Care must be coordinated through the in-network Horizon Dental Choice dentist you select as your primary care dentist.
Members enrolled in the Horizon Dental Choice Plan who do not designate a primary dentist will be automatically assigned to the office of the dentist closest to your residential ZIP code.
Exams and Preventive Services*
|Fluoride treatment (child)||$0|
Restorations and Repairs
|Composite restorations (other than for molars)||$0|
|Major restorations||50% of charges|
|Root canal therapy - anterior, bicuspid||$0|
|Root canal therapy - molar||50% of charges|
|Scaling and root planing||$0|
|Soft tissue grafts||$0|
|Osseous surgery||50% of charges|
|Soft tissue surgical extractions||$0|
|Incision and drainage of abscess||$0|
|Surgical extractions - impacted||50% of charges|
|Complete and partial dentures||50% of charges|
|Denture adjustments and repairs||50% of charges|
|Retainers and pontics||50% of charges|
|Fixed unilateral and bilateral space maintainers||50% of charges|
Orthodontic Procedures (per optional rider)*
|Children only; Limited to one complete orthodontic treatment per lifetime||50% of charges|
Services are for illustrative purposes only. For complete listing of covered services, plan limitations, deductibles and maximums, consult your Horizon Dental Choice benefit booklet.