Health Insurance Carriers > Carrier Information > Plan Brochures

Solera Dental Health Insurance in NEW HAMPSHIRE – Health Plan Options

Solera Dental — Patriot Class 1

A comparison of the Patriot Class 1 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Solera Dental — Patriot Class 3

A comparison of the Patriot Class 3 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Solera Dental — Patriot Class 4

A comparison of the Patriot Class 4 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	N/A	N/A
Office Visit	Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)	Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
Copay	Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)	Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
Deductible	N/A	N/A

Solera Dental — Patriot Class 5

A comparison of the Patriot Class 5 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	N/A	N/A
Office Visit	Doctor visit: $70/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)	Doctor visit: $70/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
Copay	Doctor visit: $70/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)	Doctor visit: $70/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
Deductible	N/A	N/A

Solera Dental — Blue Direct $1,000

A comparison of the Blue Direct $1,000 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	$20 per visit	$20 per visit
Copay	$20 per visit	$20 per visit
Deductible	Individual: $1,000, Family: $3,000	Individual: $2,000, Family: $6,000

Solera Dental — Blue Direct $2,000

A comparison of the Blue Direct $2,000 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	50%
Office Visit	$40 per visit	$40 per visit
Copay	$40 per visit	$40 per visit
Deductible	Individual: $2,000, Family: $6,000	Individual: $3,000, Family: $9,000

Solera Dental — Blue Direct $5,000

A comparison of the Blue Direct $5,000 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	50%
Office Visit	Deductible and coinsurance	Deductible and coinsurance
Copay	N/A	N/A
Deductible	Individual: $5,000, Family: $15,000	Individual: $7,500, Family: $22,500

Solera Dental — Lumenos HSA

A comparison of the Lumenos HSA offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	No cost to member after deductible100%	70%
Office Visit	No charge after deductible and coinsurance	No charge after deductible and coinsurance
Copay	N/A	N/A
Deductible	Individual: $1,250, Family: $2,500	Individual: $1,250, Family: $2,500

Solera Dental — Lumenos HSA

A comparison of the Lumenos HSA offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	No cost to member after deductible100%	70%
Office Visit	No charge after deductible and coinsurance	No charge after deductible and coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Solera Dental — Lumenos HSA

A comparison of the Lumenos HSA offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	No cost to member after deductible80%	60%
Office Visit	No charge after deductible and coinsurance	No charge after deductible and coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Solera Dental — Lumenos HSA

A comparison of the Lumenos HSA offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	No cost to member after deductible100%	70%
Office Visit	No charge after deductible and coinsurance	No charge after deductible and coinsurance
Copay	N/A	N/A
Deductible	Individual: $5,000, Family: $10,000	Individual: $5,000, Family: $10,000

Solera Dental — Lumenos HIA

A comparison of the Lumenos HIA offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% coinsurance	60% coinsurance
Office Visit	No cost to member	No cost to member
Copay	N/A	N/A
Deductible	Individual: $1,500, Family: $3,000	Individual: $1,500, Family: $3,000

Solera Dental — Lumenos HIA

A comparison of the Lumenos HIA offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% coinsurance	60% coinsurance
Office Visit	No cost to member	No cost to member
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Solera Dental — Lumenos HIA Plus

A comparison of the Lumenos HIA Plus offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% coinsurance	70% coinsurance
Office Visit	No cost to member	No cost to member
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000 (Places $200 ($400 Family) in your account to use first for covered services)	Individual: $2,500, Family: $5,000 (Places $200 ($400 Family) in your account to use first for covered services)

Solera Dental — Tonik 1500

A comparison of the Tonik 1500 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	0% coinsurance	50% coinsurance up to $8,500 per member per calendar year
Office Visit	$40 per visit	Subject to $1,500 deductible per member per calendar year and 50% coinsurance up to $8,500 per member per calendar year
Copay	$40 per visit	$40 per visit
Deductible	$1,500 deductible per member per calendar year	$1,500 deductible per member per calendar year and 50% coinsurance up to $8,500 per member per calendar year

Solera Dental — Tonik 3000

A comparison of the Tonik 3000 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	0% coinsurance	50% coinsurance up to $7,000 per member per calendar year
Office Visit	$30 per visit for the first four (4) Office Visits per member per calendar year	Subject to $3,000 deductible per member per calendar year and 50% coinsurance up to $7,000 per member per calendar year
Copay	$30 per visit	$30 per visit
Deductible	$3,000 deductible per member per calendar year	$3,000 deductible per member per calendar year and 50% coinsurance up to $7,000 per member per calendar year

Solera Dental — Tonik 5000

A comparison of the Tonik 5000 offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	0% coinsurance	50% coinsurance up to $5,000 per member per calendar year
Office Visit	$20 per visit for the first four (4) Office Visits per member per calendar year	Subject to $5,000 deductible per member per calendar year and 50% coinsurance up to $5,000 per member per calendar year
Copay	$20 per visit	$20 per visit
Deductible	$5,000 deductible per member per calendar year	$5,000 deductible per member per calendar year and 50% coinsurance up to $5,000 per member per calendar year

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — Short Term Medical

A comparison of the Short Term Medical offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$500	$500

Solera Dental — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$7,500	$7,500

Solera Dental — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$7,500	$7,500

Solera Dental — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$7,500	$7,500

Solera Dental — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$7,500	$7,500

Solera Dental — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$7,500	$7,500

Solera Dental — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$7,500	$7,500

Solera Dental — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$7,500	$7,500

Solera Dental — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$7,500	$7,500

Solera Dental — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,500, Family: $3,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,500, Family: $3,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,500, Family: $3,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,500, Family: $3,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,500, Family: $3,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,500, Family: $3,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,500, Family: $3,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — Celtic Basic - Prescription Drug Card Option

A comparison of the Celtic Basic - Prescription Drug Card Option offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — Celtic Basic - Prescription Drug Card Option

A comparison of the Celtic Basic - Prescription Drug Card Option offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — Celtic Basic - Prescription Drug Card Option

A comparison of the Celtic Basic - Prescription Drug Card Option offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $2,500, Family: $5,000	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — Celtic Basic

A comparison of the Celtic Basic offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $1,500, Family: Up to 3 times the individual deductible	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — Celtic Basic

A comparison of the Celtic Basic offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $1,500, Family: Up to 3 times the individual deductible	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — Celtic Basic

A comparison of the Celtic Basic offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $1,500, Family: Up to 3 times the individual deductible	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$5,000	$5,000

Solera Dental — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$2,600	$2,600

Solera Dental — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$1,500	$1,500

Solera Dental — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$2,600	$2,600

Solera Dental — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$1,500	$1,500

Solera Dental — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Solera Dental — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan offered by Solera Dental is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible