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DentalEssentials Online Application

This page is designed to help you select the DentalEssentials application that best fits your needs. Whether you’re an individual, a family or an agent, we’ve made it easy for you to select the right dental insurance plan. Start your application now and take the first step toward better dental health!

Here’s how to get started:

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Are you an agent/broker?

Which type of membership would you like to sign up for?

What is your Blue Cross and Blue Shield of Nebraska (BCBSNE) medical coverage status?

Individual Applicants: After you submit your application, you’ll receive a confirmation email with a copy of your completed application. If your application is approved, you’ll also receive a Schedule of Benefits Summary, which will include your dental coverage effective date. Only Nebraska HeartlandBlue members who are approved for and enrolled in DentalEssentials will receive a separate ID card. 

Agents: After you complete your part of the application, the subscriber will receive an email to review, sign, and submit it before their dental coverage can start. Both you and the subscriber will receive confirmation emails with a copy of the completed application. The subscriber will also get a Schedule of Benefits Summary that includes their dental coverage start date. Only Nebraska HeartlandBlue members who sign up for DentalEssentials will receive a separate ID card.

Choose from three plan options

Preventive Plus

I don’t go to the dentist a lot; I just go in for my preventive check-ups and cleanings.

Enhanced

I may have cavities or a tooth that needs to be pulled.

Premier

I have more complex dental issues and may require a crown or dentures.

Deductible $50 per person
per calendar year
$100 per person
per calendar year
$100 per person
per calendar year
Calendar year maximum $1,000 per person
per calendar year
$1,500 per person
per calendar year
$2,000 per person
per calendar year
Coinsurance (what you pay)
  In network Out of network In network
Out of network
In network
Out of network
Coverage A services
Preventative and diagnostic dentistry
0%
(deductible waived)
20% 0%
(deductible waived)
20% 0%
(deductible waived)
20%
Coverage B services
(6-Month Waiting Period1)
Maintenance and simple restorative dentistry and oral surgery
20%
30% 20% 30% 20% 30%
Coverage C services
(12-Month Waiting Period)
Complex restorative dentistry, periodontic and endodontics
50% 50% 50% 50% 50% 50%
Monthly premium rates
Per adult 55+ $42.51 $49.27 $54.76
Per adult <55
$33.69 $37.11 $40.05
Per dependent2 $32.33 $34.70 $36.88

Preventive Plus

I don’t go to the dentist a lot; I just go in for my preventive check-ups and cleanings.

Deductible $50 per person
per calendar year
Calendar Year Maximum $1,000 per person
per calendar year
Coinsurance (What You Pay)
  In network Out of Network
Coverage A Services
Preventative and Diagnostic Dentistry
0%
(deductible waived)
20%
Coverage B Services
(6-Month Waiting Period1)
Maintenance and Simple Restorative Dentistry and Oral Surgery
20%
30%
Coverage C Services
(12-Month Waiting Period)
Complex Restorative Dentistry, Periodontic and Endodontics
50% 50%
Monthly Premium Rates
Per Adult 55+ $42.51
Per Adult <55
$33.69
Per Dependent2 $32.33

Enhanced

I may have cavities or a tooth that needs to be pulled.

Deductible $100 per person
per calendar year
Calendar Year Maximum $1,500 per person
per calendar year
Coinsurance (What You Pay)
  In network
Out of Network
Coverage A Services
Preventative and Diagnostic Dentistry
0%
(deductible waived)
20%
Coverage B Services
(6-Month Waiting Period1)
Maintenance and Simple Restorative Dentistry and Oral Surgery
20% 30%
Coverage C Services
(12-Month Waiting Period)
Complex Restorative Dentistry, Periodontic and Endodontics
50% 50%
Monthly Premium Rates
Per Adult 55+ $49.27
Per Adult <55
$37.11
Per Dependent2 $34.70

Premier

I have more complex dental issues and may require a crown or dentures.

Deductible $100 per person
per calendar year
Calendar Year Maximum $2,000 per person
per calendar year
Coinsurance (What You Pay)
  In network
Out of Network
Coverage A Services
Preventative and Diagnostic Dentistry
0%
(deductible waived)
20%
Coverage B Services
(6-Month Waiting Period1)
Maintenance and Simple Restorative Dentistry and Oral Surgery
20% 30%
Coverage C Services
(12-Month Waiting Period)
Complex Restorative Dentistry, Periodontic and Endodontics
50% 50%
Monthly Premium Rates
Per Adult 55+ $54.76
Per Adult <55
$40.05
Per Dependent2 $36.88

1 Waived when a DentalEssentials plan is purchased at the same time that a Medicare supplement, Armor Health or Nebraska HeartlandBlue policy is purchased or renewed. 
2 Dependents are covered up to the age of 26.
Please note: DentalEssentials does not cover services for orthodontic dentistry.
Coinsurance is based on the allowable charge for a covered service. Generally, the allowable charge for covered services by in-network providers will be the contract amount. The allowable charge for covered services by out-of-network providers will be based on the contracted amount for Nebraska providers or an amount determined by the on-site plan for out-of-area providers.

Download the brochure for more details on the covered services in each category.