Dental Plan
The Dental Plan covers most types of preventive care and early treatment at 100 percent of usual and customary charges with no deductible. Other types of dental care and treatment, such as fillings, crowns, bridges, dentures and root canal therapy are paid at a percentage, detailed here. Administered by Health Alliance, you can choose any dental provider.
Dental plan benefits are separate from your medical benefits and will need to be elected separately for coverage to be effective.
| DEDUCTIBLE AND COVERAGE INFORMATION |
| |
Standard |
Enhanced |
| Annual deductible |
Individual: $50
Family: $150
Any combination of family members may satisfy the family deductible |
Individual: $50
Family: $150
Any combination of family members may satisfy the family deductible |
| Lifetime deductible for orthodontia |
Individual: $50 |
Individual: $50 |
| Policy year benefit maximum |
$1,500 |
$2,500 |
| Lifetime benefit maximum for orthodontia services |
$1,500 |
$3,000 |
| Preventive care |
0%
Limited to two per calendar year |
0%
Limited to two per calendar year |
| Basic care |
20% after deductible |
20% after deductible |
| Major care |
50% after deductible |
50% after deductible |
| Orthodontia |
50% after deductible
Limited to covered dependents under the age of 25 |
50% after deductible
Limited to covered dependents under the age of 25 |
2023 Team Member Dental Plan Premiums (Bi-Weekly)
| Full Time Rates | 30 – 40 hours per week |
| |
Standard |
Enhanced |
| Team Member |
$8.84 |
$12.60 |
| Team Member & Spouse/Domestic Partner |
$17.69 |
$25.21 |
| Team Member + Child(ren) |
$16.86 |
$24.03 |
| Family |
$25.71 |
$36.64 |
| Part Time Rates | 20 – 29.99 hours per week |
| |
Standard |
Enhanced |
| Team Member |
$11.05 |
$14.81 |
| Team Member & Spouse/Domestic Partner |
$22.11 |
$29.63 |
| Team Member + Child(ren) |
$21.07 |
$28.24 |
| Family |
$32.14 |
$43.07 |