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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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 PlusI don’t go to the dentist a lot; I just go in for my preventive check-ups and cleanings. |
EnhancedI may have cavities or a tooth that needs to be pulled. |
PremierI have more complex dental issues and may require a crown or dentures. |
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|---|---|---|---|---|---|---|
| Deductible | $50 per person per calendar year |
$100 per person per calendar year |
$100 per person per calendar year |
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| Calendar year maximum | $1,000 per person per calendar year |
$1,500 per person per calendar year |
$2,000 per person per calendar year |
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| 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 PlusI 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 | |
EnhancedI 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 | |
PremierI 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.