Basic Dental Plan

Lifetime Deductible

$50/person

Annual maximum benefit

$1,500/person

Diagnostic/preventive service: Exams,  Cleaning (including periodontal), Application of fluoride, X-rays & Space maintainers

80% * Deductible applies

 

Basic restorative services: Fillings, Surgery,  Endodontics, Periodontal procedures such as bone and gum (gingival) surgery

80% * Deductible applies

 

Major Restorative Services: Onlays, Crowns,  Bridges 

50% * Deductible applies

Orthodontia and treatment of Bruxism

Not Covered

Emergency treatment

Same as any other covered expense

* The plan pays benefits based on reasonable and customary charges.

Full-time and Part-time employees may elect employee only coverage or family coverage under the Basic Dental plan. 

Vision is included in the cost for this plan.

2011 Bi-weekly Cost:

Employee Only $7.87
Employee & Child(ren) $18.31
Employee & Spouse $15.62
Employee, Spouse & Child(ren) $25.73

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Revised: January 03, 2011.