Dental Insurance

Dental Benefits

Preferred (PPO) Dental coverage is offered through CareFirst. Refer to the Summary of Dental Benefit Changes. Employees are eligible for dental coverage per the insurance company's policies. Payment is based upon use of Participating Providers. Non-participating providers may bill you the difference between the Plan Payment and the provider's total charge.

Annual Deductible $25 Individual / $75 Family
Annual Maximum $1,000 per member/year
Lifetime Orthodontia Max    $1,500 per member (eff. 9/1/14)

80% of Allowed Benefit (no deductible) coverage for Preventive Services (reasonable & customary)

  • Routine exams and cleanings (two every 12 months)
  • Fluoride treatments for children under 19
  • Bitewing X-rays
  • Emergency treatment for dental pain (minor problems)

50% of Allowed Benefit (after deductible) coverage for Basic Services (reasonable & customary)

  • Simple restorative services (fillings)
  • Simple teeth removal
  • Non-surgical periodontic services

50% of Allowed Benefit (after deductible) coverage for Major Services (reasonable & customary)

  • Root canals and treatment involving the roots of teeth
  • Surgical periodontic services
  • Endodontics services
  • Oral surgical services
  • Dentures, full and /or partial
  • Fixed bridges, including crowns
  • Major restorative services (crowns and inlays)
  • Recementation and repair of crowns, inlays, bridges and dentures
  • General anesthesia in connection with cutting procedure

Orthodontic Services

  • 50% of Allowed Benefit (no deductible)
  • Services provided to members only until the end of the month in which a member reaches age 19
  • Length of time for treatment shall be no more than 30 consecutive months of covered services

 

Predetermination of Benefits

A member or provider may wish to obtain a written estimate of benefits available for planned dental treatment. Please refer to your benefit guide for more information on how to obtain an "Estimate of Eligible Benefits" (EEB).

For more detailed information on the Preferred (PPO) Dental Plan, click here.

Information on How To Find a Provider.

Complete a Dental Claim Form when requesting reimbursement.