The Dental Plan promotes and encourages preventive dental care and provides benefits for services that are essential to the proper care of your teeth.
who's eligible
- All regular, full-time, non-union hourly or salaried employees regularly scheduled to work at least 30 hours per week.
- Your eligible dependents. Generally, eligible dependents include:
- Your legal spouse (unless legally separated)
- Your dependent children up to age 26 (unless disabled and approved to be covered on the plan as an adult dependent), including your natural children, stepchildren, legally adopted children and children placed with you in the process of adoption. See the summary plan description for eligibility details.
- Union-represented employees if provided for in the collective bargaining agreement.
dental plan rates
Your monthly contribution is based on your family coverage level. See .
how the dental plan works
The Dental Plan is administered by Aetna. You can go to any dentist, but you'll save money when you use providers in Aetna's Dental PPO/PDN with PPO II network.
The following is an overview of the 2016 Dental Plan. For details, review the summary plan description.
plan features
| Benefit |
Annual Deductible |
$50 per individual/$150 per family |
Benefit Maximums |
|
|
$2,000 per covered individual per calendar year
|
|
Unlimited, except for orthodontic |
- Lifetime orthodontic maximum
|
$2,500 per covered dependent under age 19 |
covered services
| What You Pay* |
Preventive and Diagnostic Services
- Routine oral exams
- Cleaning and scaling of teeth
- Bitewing and diagnostic X-rays
- Fluoride application (dependents under age 16)
- Sealants
- Space maintainers
- Problem-based exams
|
Covered 100%,
no deductible |
Restorative Services
- Simple extractions
- Oral surgery
- Fillings, except gold
- Repair or re-cementing of crowns, inlays, bridgework, dentures
- Relining of dentures
- Treatment of diseases of the gums and tissues of the mouth (periodontics)
- Endodontic treatments such as root canals
- General anesthesia, if medically necessary
|
20% after deductible |
Major Services
- Crowns, inlays or gold fillings
- Dentures
- Fixed bridgework (including inlays and crowns as abutments)
|
50% after deductible |
Orthodontic Services
Braces and other orthodontic treatment for dependents under age 19 |
50%, no deductible
Up to lifetime benefit
of $2,500
|
*For out-of-network charges, you pay any amounts above usual and customary limits. |
