Results for Dental

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What's Covered Under the Basic Option

With the Basic dental option, you get coverage for preventive and basic care, including sealants, bitewing X-rays and full-mouth X-rays.

You might consider the Basic option if you and your dependents do not anticipate needing much dental care, aside from preventive and basic care.

 Basic Option
Your Deductible

You
$50

You + one or You + family
$150

The Plan Pays: Preventive Care

Plan pays 100% Includes exams, cleanings, sealants, X-rays

Basic Care

Plan pays 70% Includes extractions, fillings, root canals

Major Care

Not covered

Orthodontia

Not covered

Temporomandibular Joint Dysfunction (TMJ)

Not covered

Annual Benefits Maximum

$1,000 The most the plan pays per person

Reasonable and Customary Charges: A charge is considered “reasonable and customary” (R&C) if it matches the general cost of that service within your geographic area. If your health care provider charges above the reasonable and customary charge, you may have to pay the difference between the R&C charge and how much your provider charges.

A Note About Dental Services

There may be limitations to some of these benefits, including, but not limited to, the number of cleanings and oral exams covered in a calendar year, and time limitations for filling and crown replacements. For more information on services, go to EmployeeConnect > Your Benefit Resources > Health and Insurance > Summary Plan Descriptions.