• EligibilityMore Information

    The Plan provides Dental benefits to an active Participant or dependent of an active Participant.
     
  • Your Treatment OptionsMore Information

    In general, benefits are limited to the least costly treatment which is generally considered appropriate by the dental profession. If you choose more costly treatments, you are responsible for the difference in cost. Your treatment choices are up to you and your dentist.
     
  • Dental Calendar Year DeductibleMore Information

    $75 per Participant
    waived for Diagnostic and Preventive and Orthodontics only
     
  • Dental Calendar Year Maximum BenefitMore Information

    $2,000 per Participant (age 19 and older)
     
  • Percentages PayableMore Information

    Class I - Diagnostic and Preventive: Exams, x-rays, fluoride, cleanings, sealants. 80%; $75 deductible waived
    Class II - Basic Dental 80%
    Class III - Major Denta 50%
    Orthodontics - Individuals under age 19 50%; up to $1,200 lifetime; $75 deductible waived
     
  • Treatment PlanMore Information

    A "treatment plan" is a dentist's written report explaining proposed treatment. Whenever you expect that your expenses for a treatment plan will be more than $500, a pre-treatment estimate is recommended. The pre-treatment estimate will tell you the total charges for a treatment plan and what part of those charges will be covered by the Plan. This way, before you begin treatment, you will know how much you will have to pay. Claims not submitted for a pre-treatment estimate are subject to retrospective review by the Plan's dental consultant(s). For a pre-treatment estimate, send the treatment plan to the Administrative Office.