California Dental Plans - LIBERTY Dental Plan

Compare Our Plans

California Dental Plans

Review the costs below to determine which plan is right for you. The Annual Premium is due in full at the time of purchase. The Co-payment is the amount you pay to your dentist for the dental procedure performed.

The CA50 HMO Plan is slightly higher in annual premium, however you will pay lower co-payments for most procedures.
The CA80 Plan offers a lower annual premium than the CA50 HMO Plan, however you will pay higher co-payments. Although not required to have an assigned dentist, you ~~MUST~~ choose a network dentist.
The CA90 Plan is our most basic plan and offers the lowest annual premium, however you will pay higher co-payments than with the CA50 HMO Plan or CA80 Plan.
The Senior Rate is a discounted annual premium offered when the primary member is 65+ years of age. There is no difference in the dental coverage provided with the Senior Rate.

Annual Premiums (Yearly premium to be paid in full)

Plan Option	CA50 HMO Plan	CA80 Plan	CA90 Plan

Member	$279.51	$160.02	$120.47
Member +1	$455.73	$199.54	$154.30
Member +2 or more	$666.44	$267.05	$176.52
Senior Member( 65+ )	$253.56	$146.02	N/A
Senior Member +1( 65+ )	$412.16	$181.59	N/A
Senior Member +2 or more( 65+ )	$601.79	$242.34	N/A

Sample Discounted Fees (Co-payment due to Dentist)

ADA Code	Procedure/Description	With CA50 HMO You Would Pay	With CA80 You Would Pay	With CA90 You Would Pay	If Uninsured You Would Pay
D0150	Comprehensive oral evaluation	$0.00	$8.00	$10.00	$98.44
D0210	Intraoral, complete series of radiographic images	$0.00	$0.00	$24.00	$150.89
D1110	Prophylaxis, adult	$9.00	$0.00	$17.00	$111.40
D2150	Amalgam, 2 surfaces, primary or permanent	$13.00	$32.00	$55.00	$178.48
D2751	Crown, porcelain fused to predominantly base metal	$195.00	$280.00	$440.00	$1131.57
D3330	Root canal, Molar (excluding final restoration)	$265.00	$245.00	$395.00	$1177.53
D5110	Complete denture, maxillary	$250.00	$385.00	$500.00	$1552.14
		Click here for the full list of what's covered with the CA50 HMO	Click here for the full list of what's covered with the CA80	Click here for the full list of what's covered with the CA90

*Average "Uninsured" fees are for illustrative purposes only, based on 50th percentile of MDR and are specific to a geographic area

Compare Our Plans

CA50 HMO Plan

The CA50 plan saves you the most on your co-payments for most procedures.

Member

$279.51

Member +1

$455.73

Member +2 or more

$666.44

*Senior discounts available!

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CA80 Plan

The CA80 plan offers you lower annual premium however you will pay higher co-payments.

Member

$160.02

Member +1

$199.54

Member +2 or more

$267.05

*Senior discounts available!

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CA90 Plan

The CA90 plan is most basic plan and offers the lowest annual premium, however you will pay higher co-payments.

Member

$120.47

Member +1

$154.30

Member +2 or more

$176.52

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