$1,500 benefit maximum per plan year for Basic and Major services per covered individual
$100 Individual Deductible/$300 Family Deductible (3 or more family members)
Preventive benefits – 4 dental cleanings, bitewing x-rays, and fluoride/dental sealants (children under age 18) paid 100% when using PPO dental network providers (not subject to deductible or annual benefit maximum)
Basic services such as fillings and root canals are paid at 80% after deductible
Major services such as crowns, bridges, and dentures are paid at 50% after deductible
To view the entire PY19 Master Plan Document for the Self-Funded PPO Dental Plan click here.