Dental Coverage
Covered immediately:
- After deductible, the plan pays:
Year 1 = 60%; year 2 = 70%; year 3+ = 80% - Examinations and cleanings (twice/per year)
- Examination x-rays
- Fillings
- Non-surgical extractions – up to 4 teeth annually; excludes impacted wisdom teeth
- Diagnostic x-rays
- Diagnostic examinations
- Emergency palliative treatment
Covered after 12 months:
- After deductible, the plan pays: year 2+ = 60%
- Endodontics – includes root canals
- Periodontal surgery
- Bridges, crowns, and full/partial dentures
Vision Coverage
Covered after 6 months:
- After deductible, the plan pays:
Year 1 = 60%; year 2 = 70%; year 3+ = 80% - Pays up to $200 during any 2 policy years
- Eye examinations
- Eyeglasses
- Contact lens
Hearing Coverage
Covered after 12 months:
- After deductible, the plan pays:
year 2 = 70%; year 3+ = 80% - Pays up to $500 during any one policy year
- Hearing examinations
- Hearing aids
The above information represents a partial list of services.
Reference Outline of Coverage and policy for complete details.
Monthly Premium
Premiums are subject to change. Reference Outline of Coverage and policy for complete details.
