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All pediatric dental rates are subject to regulatory approval. The benefit details are a summary for informational and comparison purposes only and do not include the full extent of limitations and exclusions. We want you to understand what your coverage does not include before you enroll. Review the evidence of coverage / insurance policy (plan contract) for a detailed description of benefits, co-pays, coinsurance, deductibles, limitations, and exclusions. You can obtain a copy from your agent or by calling us. The overview of coverage and member cost shares are based on benefits being received from an in- network provider. Member cost shares may be more for services received from an out-of-network provider. The rates quoted here are subject to change. Rates may change for a variety of reasons including, but not limited to, plan effective date, age of applicant(s), geographic location and other factors. If there is any difference between the rates quoted on this site and the final assigned rate, the assigned rate will prevail.