Ambetter Dental And Vision
2024 Ambetter Provider Network Highlights
For a complete list of Ambetter in-network providers, please visit here
Ambetter Adult Dental and Vision Benefits
Coverage Area: Bond County, Calhoun County, Clinton County, Cook County, DuPage County, Greene County, Grundy County, Henry County, Jersey County, Kane County, Kankakee County, Kendall County, Lake County, Macoupin County, Madison County, Mercer County, Monroe County, Montgomery County, Randolph County, Rock Island County, St. Clair County, Washington County, Will County
Adult Dental* (19 years of age and older)
| 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 |
Adult Dental (19 years of age and older, does not include pediatric dental coverage)
| 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 |
