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BCI logo All Dental benefits utilize a PPO provider network regardless of the type of medical plan you have selected. 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:

  1. Deductibles and Benefit Limits are per benefit period except the Orthodontic Benefit Limit which is a lifetime limit.
  2. 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: $50 per member (except listed preventive services) • Pediatric Orthodontia Benefit: $1,000 lifetime maximum

TypeCovered Service
(see contract for full list)
In-Network Contracting Providers - PPO
Out-of-Network Providers
Preventative & DiagnosticOral exam & cleanings100%, no deductible70% after deductible
BasicFillings, extractions,
root canals, etc.
80% after deductible50% after deductible
MajorCrowns, bridges, dentures50% after deductible50% after deductible
Orthodontic (Pediatric)Pediatric benefit only50% after deductible50% after deductible
Other80% after deductible70% after deductible
For details about premiums, please see Premium Rates.




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