Benefit Summary: Dental


Overview

In general, the Plan covers necessary dental expenses at 80% of the usual and customary charges for services rendered, subject to the annual deductible and maximum benefit, the treatment plan requirement, and other specific limitations.

The Dental Benefit is available to all active employees and their covered dependents, as well as retirees who have chosen dental and vision coverage and their covered dependents.



Dental Network of America

Lineco uses a dental preferred provider organization (PPO) called the Dental Network of America (DNoA). Use of a PPO provider is voluntary.

To find a DNoA dentist, go to www.dnoa.com or call 1-(866)-522-6758 between 7:30 a.m.-6 p.m. CST.



Your Treatment Options

In general, benefits are limited to the least costly treatment which is generally considered appropriate by the dental profession. If you choose more costly treatments, you are responsible for the difference in cost. Your treatment choices are up to you and your dentist.


Treatment Plan

Have your dentist submit a treatment plan and request a pre-treatment estimate prior to beginning work which will total more than $1000. This way you will be sure of what the Plan will cover before you receive treatment.


Dental Calendar Year Deductible

$100 per Covered Person

Dental Calendar Year Maximum Benefit

$2,000 per Covered Person – all services apply to max.

Patients Age 0-20
Dental Calendar Year Maximum Benefit

$2,000 per Covered Person
Exclusion: See Diagnostic and Preventative

Diagnostic and Preventive:
Exams, x-rays, fluoride, cleanings, sealants.

80%
No deductible

Patients Age 0-20
Diagnostic and Preventive:
Exams, x-rays, fluoride, cleanings, sealants

100%
No deductible
No maximum

Restorative Dental:
Fillings, root canals, periodontal work, extractions, anesthesia, crowns, dentures, bridgework.

80%

Orthodontics - Dependent children only

80%; up to $2,000 lifetime maximum
No deductible