Description
Plan Highlights
Annual Max $5,000***
**$2,000 Plan buy up option for total $5,000 Plan benefit, self-funded by administrator
Preventive Services
Type I - 100% Coverage
No waiting period. No Deductible.
Includes oral exams (2 per 12 months), cleanings (2 per 12 months), bitewing x-rays (1 per 12 months), and fluoride treatment.
Basic Services
Type II - 80% Coverage
No waiting period. $50 Individual Deductible.
Maximum Deductible per Family: 3 times the Individual.
Includes fillings, full mouth x-rays, restorative amalgams, composites, simple extractions, and sealants.
Major Services
Type III - 50% Coverage
12 month waiting period.$50 Individual Deductible.
Maximum Deductible per Family: 3 times the Individual.
Includes oral surgery, endodontics, complex extractions, periodontics, onlays, anesthesia, dentures (1 appliance per 5 years), crowns (1 per tooth, per 7 years), bridges (1 per 7 years), and implants.
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