When an employee enrolls in a medical plan they are required to enroll for at least self-only dental coverage. They may continue with self-only coverage, regardless of the number of dependents on their medical plan, or they can elect family dental coverage. The dental premiums are based on the number of people enrolled.
Dental benefits are paid at a Traditional or PPO participating provider level based on the contracting status of your dentist at the time of service. Deductibles and benefit payments are based on allowable charges. Review the Dental Plan Contract posted below for details on waiting periods, exclusions and benefit amounts.
Dental Provisions to Know:
- For all new enrollees there is a twelve (12) month waiting period for Crowns, Bridges, Dentures and Dental Implants, including related services.
- 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.
Dental Plan Comparison
Plan Year Benefit: $1,500 maximum per member benefit • Deductible: $25 per member (except PPO preventive & diagnostic) • Pediatric Orthodontia Benefit: $1,000 lifetime maximum
(see contract for full list)
|In-Network Contracting Providers - PPO||In-Network Contracting Providers - Traditional||Out-of-Network Providers|
|Preventative & Diagnostic||Oral exam & cleanings||80%, no deductible||70% after deductible||70% after deductible|
|Basic||Fillings, extractions, |
root canals, etc.
|80% after deductible||50% after deductible||50% after deductible|
|Major||Crowns, bridges, dentures||50% after deductible||50% after deductible||50% after deductible|
|Orthodontic (Pediatric)||Pediatric benefit only||50% after deductible||50% after deductible||50% after deductible|
|Other||80% after deductible||70% after deductible||70% after deductible|