Dental Coverage
The following chart summarizes the dental benefits for the Dental plan offered to all eligible employees.
Dental PPO Plan
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Annual Deductible (waived for preventive) | $50 / Individual $150 / Family | $100 / Individual $300 / Family |
| Annual Maximum | $1,000 / Person | $1,000 / Person |
| Oral Exam, X-rays, Cleanings | 100% | 80% |
| Fillings, Simple Extractions | 100% | 80% |
| Periodontics (Gum Treatment) | 100% | 80% |
| Endodontics (Root Canals) | 100% | 80% |
| Crowns, Dentures, Bridges | 60% | 50% |
| Child/Adult Coverage | 50% to $1,000 Lifetime | |
Dental Preferred Provider Organization (DPPO):
- When visiting an out-of-network dentist, please remember that you are responsible for amounts in excess of charges above the allowable amounts. Out-of-network dentists are not contracted with the carriers; therefore, members may expect to pay more for utilizing a dentist outside of the network.
- A pre-determination of benefits is recommended for treatment plans that amount to $300 or greater so you can make an informed decision.
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