Providing benefits for state employees and retirees

Employee Group Insurance Benefits

Dental Plan Snapshot

Benefits are paid at the Traditional and PPO participating provider levels based on the contracting status of your dentist at the time services are rendered.

Please keep in mind that deductibles and benefit payments are based on allowable charges. For details about the dental plan, waiting periods, limitations, and how the plan works, please see the Benefits Summary & Plan Contracts.

Deductible* In-Network
Contracting
Providers
Out-of-Network
Providers
Benefit
Limit*
Links
PPO Traditional PPO Traditional
Preventive none $25 80% 70% 70% $1,000
Benefits
Summary



Plan
Contract
Diagnostic 80% 70% 70%
Other $25 80% 70% 70%
Basic 80% 50% 50%
Major 50% 50% 50%
Orthodontic** 50% 50% 50% $1,000 (lifetime)

* Deductibles and Benefit Limits are per benefit period except the Orthodontic Benefit Limit which is a lifetime limit.

** Orthodontic services are for eligible dependent children up to age 19 if the treatment has begun by age 17.


QUESTIONS?
Phone:
Fax:
Email:
(208) 332-1860 or (800) 531-0597
(208) 332-1888
ogi@adm.idaho.gov


Snapshots

In order to provide quick and easy plan data, some of the information provided on this website is abbreviated. Please consult the Benefits Summary & Plan Contracts for complete documentation.

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