Kaiser Permanente

Optional Dental Plans
Benefit Highlights	Plan 1	Plan 2	Plan 3
Benefit maximum	None	None	None
Deductible	$50	$50	$100
Benefits	Member pays
Preventive and diagnostic services*	No charge	20%	20%
Basic restorative services	50%	50%	50%
Oral surgery, endodontics, and periodontics	75%	75%	75%
Major restorative services	75%	75%	75%
Orthodontics* (for children and adults)	75%	75%	75%
*Not subject to the deductible.
Monthly Premiums	0-24 years	25-44 years	45+ years
Plan 1
Child/Subscriber only	$39.53	$41.90	$44.27
Subscriber + spouse/domestic partner	$79.06	$83.80	$88.54
Subscriber + child	$79.06	$81.43	$83.80
Subscriber + children	$122.54	$140.73	$143.10
Subscriber, spouse + child	$118.59	$123.33	$128.07
Subscriber, spouse + children	$162.07	$182.53	$187.37
Plan 2
Child/Subscriber only	$35.58	$37.71	$39.85
Subscriber + spouse/domestic partner	$71.16	$75.42	$79.70
Subscriber + child	$71.16	$73.29	$75.43
Subscriber + children	$110.30	$126.66	$128.80
Subscriber, spouse + child	$106.74	$111.00	$115.28
Subscriber, spouse + children	$145.88	$164.37	$168.65
Plan 3
Child/Subscriber only	$32.76	$34.73	$36.69
Subscriber + spouse/domestic partner	$65.52	$69.46	$73.38
Subscriber + child	$65.52	$67.49	$69.45
Subscriber + children	$101.56	$116.63	$118.59
Subscriber, spouse + child	$98.28	$102.22	$106.14
Subscriber, spouse + children	$134.32	$151.36	$155.28
With our Individuals and Families Dental Plans, you get the comprehensive benefits you need and high quality of care you've come to expect from Kaiser Permanente. Key features include the following: There is no calendar-year benefit maximum. There is no waiting period-you can begin receiving your covered services the moment your coverage takes effect. Orthodintia coverage is included.