Preferred Dental Plan
The Preferred Plan offers more comprehensive benefits, including orthodontia for dependent children to age 19, at a higher premium. If you use an out-of-network dentist, you may be required to pay the provider at the time of service, and you will incur higher out-of-network costs, including charges over the maximum allowable charge (MAC).
Now included: Preventive Incentive! Any Class I diagnostic or preventive service will not count toward the annual maximum.
The Preferred Plan also includes a pregnancy benefit that covers 1 additional cleaning, 1 additional periodontal maintenance, scaling and root planing, and 4 periodontal surgery procedures during pregnancy.
Weekly Dental Premium Rates
|Employee||EE + Child||EE + Spouse||Family|
|Waived for Preventive?||Yes||Yes|
|Dental Annual Maximum||$1,500||$1,500|
|Class I Diagnostic/Preventive Coinsurance|
|All other X-rays||100%||75%|
|Cleanings & Fluoride Treatments||100%||75%|
|Class II Basic Coinsurance|
|Basic Restorative (Fillings)||100%||75%|
|Complex Oral Surgery||100%||75%|
|Class III Major Coinsurance|
|Inlays, Onlays, Crowns||80%||60%|
|Prosthetics (Bridges, Dentures)||80%||60%|
|Repairs of Crowns, Inlays, Onlays, Bridges & Dentures||80%||60%|
|Diagnostic, Active, Retention, Treatment||50%||35%|
|Child Ortho. Lifetime Maximum||$1,000||$1,000|