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 Calendar Year Deductible
$100 per Covered Person, waived on preventative services.
Dental Calendar Year Maximum Benefit
$2,000 per Covered Person — all services apply to max except preventative care for children under age 21.
Patients Age 0-20 Dental Calendar Year Maximum Benefit
$2,000 per Covered Person
Exclusion: See Diagnostic and Preventative