When Do You Receive Dental Benefits
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What Percentage of Covered Dental
Expenses Does the Plan Pay
What Is the Annual Maximum Benefit
What Is the Pre-Treatment Estimate
of Benefits
Like medical coverage, dental coverage provides benefits
for appropriate treatment at the usual and prevailing cost.
The plan provides benefits for preventive care, as well as
major dental care.
What Percentage of Covered Dental
Expenses Does the Plan Pay
The plan pays 100% of covered expenses for preventive care
such as checkups and cleanings, but not more than twice in
any 12-month period. For dependents under 19 years old, the
plan pays 100% of covered expenses for fluoride treatments,
space maintainers, and sealants (no more often than once every
three years for any given permanent tooth).
The plan pays 75% of covered expenses for many major dental
services. You are responsible for paying the remaining 25%.
You can be reimbursed for your share of covered expenses if
you have a Flexible Spending health care account. Among the
services paid at 75% are:
- One full mouth X-ray, no more often than every three years
- Supplemental bitewing X-rays, no more often than once
every six months
- Fillings, inlays, and crowns
- Treatment of periodontal and other diseases of the gums
and tissues of the mouth
- Endodontics
- Extractions and oral surgery
- X-rays to diagnose a condition requiring treatment
- Anesthesia and antibiotics
- Medications prescribed by your dentist.
The plan pays 50% of covered expenses for dentures and bridges.
Your Flexible Spending health care account can reimburse your
share of the cost.
Replacements are also covered. Dentures will be replaced
with dentures, unless a bridge is absolutely necessary. Replacements
will be made only if the existing denture or bridge cannot
be repaired and is at least five years old, or if the existing
denture is temporary and less than 12 months old. The plan
will also pay for adding teeth to dentures or bridges if required.
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What Is the Annual Maximum Benefit
The maximum benefit payable for each covered person during
each plan year is $2,000.
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What Is the Pre-Treatment Estimate
of Benefits
If your dental treatment is expected to cost more than $150,
you and your dentist should file a description of the services
to be performed and an estimate of the cost with the carrier
before treatment begins. In this way, you will know in advance
how much the plan will pay. Also, because costs of dental
service and treatment may vary, you and your dentist will
be able to decide in advance on the most appropriate course
of treatment.
A pre-treatment estimate is not necessary for emergency treatment.
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