Learn more about Highlights, Eligibility, Plan Details and Frequently Asked Questions.
COVERAGE LIMITS
|
Group Basic Dental Insurance Plan |
Group Enhanced Dental Insurance Plan |
|
Annual Maximums
You and your covered dependents are entitled to receive up to $1,000 each in dental benefits per calendar year after the deductible is satisfied.
A lifetime maximum benefit of $850 applies to orthodontic benefits for insured dependent children under age 19.
Dental Procedure Maximums
View Schedule of Dental Services for listing of covered services and maximum amount paid for each procedure. |
Annual Maximums
You and your covered dependents are entitled to receive up to $1,200 each in dental benefits per calendar year after the deductible is satisfied.
A lifetime maximum benefit of $850 applies to orthodontic benefits for insured dependent children under age 19.
Dental Procedure Maximums
View Schedule of Dental Services for listing of covered services and maximum amount paid for each procedure. |
Deductible
- The calendar year deductible is $50 per insured person, up to $150 maximum per family.
- The deductible does not apply to preventive services.
- The deductible is applied against insurance-covered expenses, not billed charges.
Waiting Period
- Preventive, diagnostic, restorative (except major) and adjunctive services are provided immediately.
- Endodontics and oral surgery services have a 6 month waiting period.
- All other services have a 12 month waiting period.
- Once you have been enrolled under the plan for 12 consecutive months, you are eligible for restorative-major, periodontics, prosthetics-removable and fixed bridge services.
- Insured dependent children under age 19 qualify for orthodontic services after a 12 month waiting period.
RATES
Below are the monthly and quarterly premium contributions for the Group Basic Dental and Group Enhanced Dental plans.
Group Enhanced Dental offers you a choice of plans with or without orthodontic services for insured dependent children under age 19.
|
Group Basic Dental Insurance Plan |
Group Enhanced Dental without Orthodontics |
Group Enhanced Dental with Orthodontics |
|
Payment Plan |
Monthly |
Quarterly |
Monthly |
Quarterly |
Monthly |
Quarterly |
|
Member Only |
$26.67 |
$80.00 |
$38.67 |
$116.00 |
$38.67 |
$116.00 |
|
Member +1 |
47.33 |
142.00 |
64.77 |
194.30 |
68.63 |
205.90 |
|
Family |
65.33 |
196.00 |
83.62 |
250.85 |
94.73 |
284.20 |