top Employee Benefit Program
Dental Plan

      

Calendar Year Deductible         $40 per Participant / $100 per Family

Calendar Year                                                    $1,200

Benefit Maximum
Type I Services (Preventive)
Routine exams (preventive and diagnostic), bitewing x-rays, and cleaning and scaling covered two times in calendar year; annual fluoride application for child(ren); full mouth x-rays once every three years.  Emergency treatment for the relief of pain. Payable at 80%, not subject to calendar year deductible.

Waiting Period: None
Type II Services (Basic)
Space maintainers; sealants; extractions; treatment of the gums; fillings (other than gold); root canals; anesthetics; dental prescriptions; injectable antibiotics; laboratory exams and tests. Payable at 80%, after satisfaction of the calendar year deductible.

Waiting Period: None
Type III Services (Major)
Gold fillings; crowns; bridges; dentures. Payable at 50%, after satisfaction of the calendar year deductible.

Waiting Period: Six (6) months on the Plan
Type IV Services (Orthodontia)
Braces Payable at 50%, not subject to calendar year deductible.  Not subject to the Calendar Year Benefit Maximum, but is subject to $2,000 Lifetime Maximum per Participant.

Waiting Period: Six (6) months on the Plan

 

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