Dental

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:

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

Type	Covered Service (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

For details about premiums, please see Premium Rates.