Dental Care
Last updated: February 4, 2013
Most, but not all, dental services and supplies that are provided by a dental care provider and are determined by the Plan administrator or its designee to be “medically necessary” are covered. Refer to the Plan Document for details.
Usually, you will have to satisfy a deductible and pay some coinsurance toward the amounts you incur that are eligible dental expenses.
Overview of Dental Deductible, Plan Maximums and Coinsurance
| Annual Deductible |
|---|
| What you must pay each year before the Plan pays benefits. |
| Individual: $50 Family: $100 |
| Annual Dental Plan Maximum |
|---|
| The most the Plan will pay for covered expenses in one year. |
| $1,500 per person per year. (This maximum does not apply to children under age 18.) |
| General Overall (Lifetime) Maximum Plan Benefit |
|---|
| The most this Plan will pay for all covered expenses for one person. |
| $1,500 for orthodontia $350 for non-surgical TMJ services |
| Coinsurance |
|---|
| How you and the Plan will split the cost of covered expenses. |
| Preventive: 100% Basic: 80% Major: 50% Orthodontia: 50% (All services are subject to the deductible except preventive.) |
All annual deductibles and annual maximum plan benefits are determined during the Plan year beginning July 1 and ending June 30.