Preferred Dental Plan

The Preferred Plan offers more comprehensive benefits, including child orthodontia, 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).

Weekly Dental Premium Rates

Employee EE + Child EE + Spouse Family
$3.95 $9.58 $16.48 $28.05

Out-of-Pocket Costs

  In-Network Out-of-Network
Individual Deductible $25 $50
Family Deductible $75 $150
Out-of-Net. Reimbursement   MAC
Waived for Preventive? Yes Yes
Dental Annual Maximum $1,500 $1,500
Preventive Coinsurance 100% 75%
Basic Coinsurance 100% 75%
Major Coinsurance 80% 60%
Child Orthodontia 50% 35%
Child Ortho. Lifetime Maximum $1,000 $1,000
Non-surgical Periodontics 100% 75%
Surgical Periodontics 100% 75%
Prosthetics (Bridges & Dentures) 80% 60%