Small Employer
Dental Plans
Participating
Non Participating
Participating
DEDUCTIBLE
Individual $50/$100
Family $150/$300
Non Participating
DEDUCTIBLE
Individual $50/$100
Family $150/$300
Participating
ANNUAL MAXIMUM PLAN PAYMENT
Per person, per calendar year
$1,000/$1,500/$2,000
Non Participating
ANNUAL MAXIMUM PLAN PAYMENT
Per person, per calendar year
$1,000/$1,500/$2,000
Participating
PREVENTIVE AND DIAGNOSTIC
Oral exams, cleanings, fluoride, x-rays (No waiting period)
Plan pays 100%
Non Participating
PREVENTIVE AND DIAGNOSTIC
Oral exams, cleanings, fluoride, x-rays (No waiting period)
Plan pays 80%
Participating
BASIC
Fillings, oral surgery, anesthesia for basic services (Six month waiting period without prior coverage)
Plan pays 80% after deductible
Non Participating
BASIC
Fillings, oral surgery, anesthesia for basic services (Six month waiting period without prior coverage)
Plan Pays 60% after deductible
Participating
IMPLANTS
Plan pays 50% after deductible
Non Participating
IMPLANTS
Plan pays 50% after deductible
Participating
MAJOR
Crowns, bridges, dentures, anesthesia for major services, endodontics and periodontics (12 month waiting period without prior coverage)
Plan pays 40% after deductible
Non Participating
MAJOR
Crowns, bridges, dentures, anesthesia for major services, endodontics and periodontics (12 month waiting period without prior coverage)
Plan pays 50% after deductible
Participating
ORTHODONTICS
Buy-up option for contributory plans with employers who have at least 10 employees enrolling in dental
Plan pays 50%
Non Participating
ORTHODONTICS
Buy-up option for contributory plans with employers who have at least 10 employees enrolling in dental
Plan pays 50%
Participating
ORTHODONTIC LIFETIME MAXIMUM PLAN PAYMENT
Per person
$1,000/$1,500
Non Participating
ORTHODONTIC LIFETIME MAXIMUM PLAN PAYMENT
Per person
$1,000/$1,500