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Comprehensive Dental Care Program

 

This Dental Care Program offers complete coverage for preventive services, along with additional coverage for primary and major dental services.  Employees and each eligible dependent will receive a maximum of $2,000 in benefits for all covered services each anniversary year.

Preventive

No Deductible - 100% Payment

  • Oral examinations
  • Dental imaging required to treat or diagnose diseases or abnormalities of the teeth, surrounding tissue, and cavity detection
  • Fluoride application is available through the end of the month in which an insured reaches the age of 21
  • Prophylaxis, including cleaning, scaling and polishing
  • Sealants (One application every four years for each eligible individual age 5-17, for permanent first and second molars)
  • Space Maintainers

Primary and Major Dental Benefits have a combined deductible maximum of $25 for an individual, $50 for a family.

Primary

80% Payment.

  • Emergency treatment for pain
  • Fillings (except gold)
  • Simple extractions
  • Inlays 
  • Endodontics, including pulpotomy, pulp capping and root canal treatment
  • General anesthesia when the dental treatment is covered
  • Repair of dentures
  • Periodontics, non-surgical
  • Non-surgical care of acute oral infection and oral lesions
  • Oral surgery, consisting of diagnosis and treatment of fractures, dislocations, cysts, and abscesses; and surgical extractions (including impacted teeth)

Major

50% Payment.

  • Dental implant services
  • Periodontal surgery
  • Surgery of the bony structure supporting the teeth

The following services are subject to a 240-day waiting period:

  • Onlays (not part of a bridge)*
  • Crowns (not part of a bridge)*
  • Dentures, full or partial*
  • Bridges*

*Benefits are not provided for denture or bridge replacement within five years after receiving dentures or bridges under this program. Benefits are limited to standard procedures for prosthodontic services.

Orthodontics (age 21 or under) - Annual maximum $750; 3 year maximum $1,500