You Are Here:

Benefits At A Glance

Dental Care
 Option AOption BOption C
Basic/Preventive Services

(Examinations, x-rays, cleaning and polishing, fillings, extractions)
Coverage

8 units scaling and/or root planing per year
4 units of facility fees for surgical extracts

80%
No annual
maximum; inside
limits apply
80%
No annual
maximum; inside
limits apply
65%
No annual
maximum; inside
limits apply
Minor Restorative Services
(Root canal treatment, gingival curettage)
Coverage

Endodontics
Periodontics

80%
Combined maximum: $750 per calendar year
80%
Combined maximum: $750 per calendar year
65%
Combined maximum: $750 per calendar year
Major Restorative Services
(Crowns on natural teeth)
Coverage

Crowns, Posts, and Inlays and onlays.
(Crowns on natural teeth)

50%
Combined maximum: $800 per calendar year
Major Restorative Services
(Implants, crowns on implants, partial and full bridges, partial and full dentures, etc.)
Coverage

(Implants, crowns on implants, partial and full bridges, partial and full dentures, etc.)

50%
Combined maximum: $800 per calendar year