Dental Plan
The Carle Health Dental Plan covers most types of preventive care and early treatment at 100% 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 |
2025 Team Member Dental Plan Premiums (Bi-Weekly, 24 pay periods)
| 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 |
SCENARIOS
Scenario 1 (oldest child with braces)
Alex is 45 years old, working full-time with two children covered on the Dental Plan. This year, Alex’s oldest needed braces.
| |
STANDARD |
ENHANCED |
| |
Serivce Provided |
Cost Incurred |
Service Provided |
Cost Incurred |
Orthodontia Services
($5,000 Total Charges) |
$50 deductible
$4,950 (50% coinsurance of remaining charges up to lifetime limit) |
+$50
+$3,450 |
$50 deductible
$4,950 (50% coinsurance of remaining charges up to lifetime limit) |
+$50
+$2,475 |
| Annual Premiums |
$16.86 bi-weekly premium (x24 pay periods) |
+$404.64 |
$24.03 bi-weekly premium (x24 pay periods) |
+$576.72 |
|
Annual Exam and Cleaning
|
($0 covered under preventive care) |
$0 |
($0 covered under preventive care) |
$0 |
| Tax Savings Opportunity |
Flexible Spending Acccount
Health Savings Account |
|
Flexible Spending Acccount
Health Savings Account |
|
| Cost Summary |
|
$3,904.64 |
|
$3,101.72 |
Scenario 2 (Basic and major care needs for spouse)
Eric is 30 years old and works full-time covering a spouse on dental coverage. This year Eric’s spouse needed a filling and two crowns.
| |
STANDARD |
ENHANCED |
| |
Service Provided |
Cost
Incurred |
Service Provided |
Cost Incurred |
Filling for one tooth
($250 total charges) |
$50 deductible
$40 (20% coinsurance on remaining charges) |
+$90
|
$50 deductible
$40 (20% of remaining charges) |
+$90 |
Crown for one tooth
($2,000 total charges) |
$1,000 (50% coinsurance) |
+$1,000 |
$1,000 (50% coinsurance) |
+$1,000 |
Crown for one tooth
($1,200 Total Charges) |
50% coinsurance up to the annual limit |
+$860
Annual limit met |
50% coinsurance up to the annual limit |
+$600 |
| Annual Cleanings |
$0 (Covered at 100% under preventive care) |
+$0 |
$0 (Covered at 100% under preventive care) |
+$0 |
| Annual Premiums |
$17.69 bi-weekly premium (x24 pay periods) |
+$424.56 |
$25.21 bi-weekly premium (x24 pay periods) |
+$605.04 |
| Tax Savings Opportunity |
Flexible Spending Acccount
Health Savings Account |
|
Flexible Spending Acccount
Health Savings Account |
|
| Cost Summary |
|
$2,374.56 |
|
$2,295.04 |