Annual Health Insurance Open Enrollment Period
April 10, 2018 through April 27, 2018
Coverage Effective July 1, 2018
Dental Insurance
| |
Dental Blue Program 1 |
Dental Blue Program 2 |
| Policy #: |
2281513 |
2327879 |
| Coverage |
|
|
| Preventive Procedures: |
100% |
100% |
| |
Diagnostic (x-rays, oral exams), preventive (cleanings, fluoride treatments, sealants), other covered services |
Diagnostic (x-rays, oral exams), preventive (cleanings, fluoride treatments, sealants), other covered services |
| Basic Procedures: |
80% |
80% |
| |
Restorative (fillings), oral surgery (extractions), periodontics (gum and bone), endodontics (root and pulp), prosthetic maintenance, other covered services |
Restorative (fillings), oral surgery (extractions), periodontics (gum and bone), endodontics (root and pulp), prosthetic maintenance, other covered services |
| Major Procedures: |
|
50% |
|
|
Prosthodontic (teeth replacement, dentures, fixed bridges and crowns), major restorative (crowns), other covered services |
| Orthodontics: |
100% |
100% |
| Annual Deductible |
|
|
|
Applies to basic services |
Applies to basic and major services |
| Individual: |
$25 |
$50 |
| Family: |
$75 |
$150 |
| Benefit Maximums |
|
|
| Calendar Year: |
$500 |
$1,500 |
| Orthodontic Lifetime: |
$500 |
$1,500 |