What You Pay in the Dental Plan

Premium Option Basic Option
Annual Deductible $50 Individual
$150 Family
$100 Individual
$300 Family
Calendar-year Maximum $2,500 per person $1,250 per person
Diagnostic & Preventive Services
Exams, two cleanings per year, x-rays, topical fluoride treatments for children 1x/year to age 15, sealants once every 60 months to age 19
Covered at 100% (no deductible) Covered at 100% (no deductible)
Basic Services
Extractions, fillings and oral surgery except removal of wisdom teeth, repair or recementing of crowns, and relining of dentures
Plan pays 80% after deductible Plan pays 80% after deductible
Major Services
Inlays, first installation of bridgework, dentures and crowns, implants, removal of impacted teeth
Plan pays 50% after deductible Plan pays 50% after deductible
Orthodontia Plan pays 50% after deductible up to a lifetime maximum of $1,500
Dependent children only up to age 26.
Plan pays 50% after deductible up to a lifetime maximum of $1,000
Dependent children only up to age 19.