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Plan Details

  Premium Plan
     Deductible for B & C Services and Implants-
  • $50 per member
  • $150 per family
Deductible is waived for Type A services including Diagnostic & Preventive
Examples of Covered Services*      
Type A Services
Sealants- children to age 16
Fluoride- children to age 19
Diagnostic & Preventive

Plan pays up to a combined total $1,800 worth of A, B, and C services per member per year.  
Member pays 100% after that.

20% Co-insurance on type B Services
50% Co-insurance on type C Services

Type B Services
Endodontics (root canals)
Oral Surgery
Periodontics (gum treatment)
Restorative (all fillings) 
Type C Services
Prosthodontics  (inlays, onlays, bridges, and dentures)
Implants     50% coinsurance
$1,500 Lifetime Limit.  Member Pays 100% after that.