The benefits of the dental plan are based on cost sharing features that include a deductible and coinsurance. Plan benefits and your out-of-pocket costs will differ depending on the provider you choose.

The member deductible on combined basic and major restorative services is $25 for individuals and $75 for families. $2500 calendar year maximum benefit for preventative, basic, and major restorative services. 

Preventative Services covered at 100% 

• Routine oral exams.
• Cleanings.
• Bitewing X-rays.  

Basic Restorative Services covered at 85% 

• Extractions, including wisdom teeth. 
• Root canals. 
• Fillings. 
• Oral Surgeries. 

Major Restorative Services Covered at 60% 

• Dentures. 
• Dental Implants. 
• Initial placement of full or partial removable dentures.
  

Orthodontic Services covered at 50% 

• Up to age 19. 
• TMD benefits.
• Molar uprighting. 
• 12-month waiting period.