EssentialSmile Arizona – Total Care

34095AZ0010001
High
EPO

EssentialSmile Arizona – Total Care is a High EPO plan by Solstice Healthplans of Arizona, Inc..

Locations

EssentialSmile Arizona – Total Care is offered in the following counties.

Plan Overview

This is a plan overview for 2025 version of EssentialSmile Arizona – Total Care 34095AZ0010001.
Insurer: Solstice Healthplans of Arizona, Inc.
Network Type: EPO
Metal Type: High
HSA Eligible?:
Plan ID: 34095AZ0010001

Cost-Sharing Overview

EssentialSmile Arizona – Total Care offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for EssentialSmile Arizona - Total Care?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

EssentialSmile Arizona – Total Care offers the following features and referral requirements.

Wellness Program:
Disease Program:
Notice Pregnancy:
Referral Specialist:
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what EssentialSmile Arizona – Total Care covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Only for palliative care where a network provider is not available.
National Network: No

Additional Benefits and Cost-Sharing

EssentialSmile Arizona – Total Care includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Routine Dental Services (Adult)
Covered
$10.00 Not ApplicableNot Applicable 100.00%
Dental Check-Up for Children
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Basic Dental Care – Child
Covered
No Charge after deductible Not ApplicableNot Applicable 100.00%
Orthodontia – Child
Covered
$350.00 Copay after deductible Not ApplicableNot Applicable 100.00%
Major Dental Care – Child
Covered
$350.00 Copay after deductible Not ApplicableNot Applicable 100.00%
Basic Dental Care – Adult
Covered
$56.00 Not ApplicableNot Applicable 100.00%
Orthodontia – Adult
Covered
$3,700.00 Not ApplicableNot Applicable 100.00%
Major Dental Care – Adult
Covered
$260.00 Not ApplicableNot Applicable 100.00%
Accidental Dental

Free Preventive Services

There is no copayment or coinsurance for any of the following EssentialSmile Arizona – Total Care preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Ready to sign up for EssentialSmile Arizona - Total Care?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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