Ambetter Dental & Vision

Ambetter offers Dental and Vision plans for individuals and families in Illinois.

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Ambetter Adult Dental and Vision Benefits

Service	In-Network	Out-of-network
Routine Eye Exam	100% Covered	Not Covered
Eyeglasses (frames)	Covered up to $130	Not Covered
Lenses (per pair)	100% Covered	Not Covered
Contact Lenses (in lieu of glasses)	Covered up to $130	Not Covered

Preventative and Diagnostic (Class 1)	In-Network	Out-of-network
Routine Cleaning	No Charge	Not Covered
Oral Exam	No Charge	Not Covered
X-Ray – bite – wing, full-mouth and panoramic film	No Charge	Not Covered

Minor Restorative (Class 2)	In-Network	Out-of-network
Minor Restorative – metal and resin-based fillings	50% Coinsurance	Not Covered
Endodontic Therapy	50% Coinsurance	Not Covered
Periodontics – scaling, root planning, and periodontal maintenance	50% Coinsurance	Not Covered
Simple Extractions	50% Coinsurance	Not Covered
Prosthodontics – relines, rebase, adjustment, and repairs	50% Coinsurance	Not Covered

Major Restorative (Class 3)	In-Network	Out-of-network
Crowns and Bridges	50% Coinsurance	Not Covered
Dentures	50% Coinsurance	Not Covered
More Complex extractions and surgical services	50% Coinsurance	Not Covered