Archive: Dental 2022

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  • $2,000 or $2,500 benefit coverage
  • Two preventive basic cleanings each year at no cost
  • Basic and major dental services coverage
  • Providers nationwide
  • Orthodontia benefits on the Dental Plus plan
Dental Plans
Platinum Network
Dental (2000)
Summary Plan Description
2019 amendment 		Dental Plus (2500)
Summary Plan Description
2019 amendment
Contracted Dentist Non-Contracted Dentist Contracted Dentist Non-Contracted Dentist
Preventive
Routine exams, cleanings (2 per year), topical fluoride, x-rays, space maintainers, sealants 100% 100% of R&C 100% 100% of R&C
Basic
Composite fillings, extractions, oral
surgery, endodontics, periodontics
(No Waiting Period) 		80% 80% of R&C 80% 80% of R&C
Major
Crowns, bridges, dentures, surgical
implants
​(No Waiting Period) 		50% 50% of R&C 50% 50% of R&C
Orthodontics
Lifetime Maximum
All Members 		No Benefit
20% Discount 		No Benefit $2000
20% Discount 		$2000
Maximum Benefit (Applies to Basic and Major Services Per Benefit Period)
Benefit Period is Per Calendar Year $2,000 $2,500
Deductible (Per Benefit Period)
Per Person:
Family Maximum: 		$50.00
$150.00 		$50.00
$150.00 		​$50.00
$150.00 		$50.00
$150.00
Specialists Contracted Specialist payment: Non-contracted Specialist payment: Contracted Specialist payment: Non-contracted Specialist payment:
Endodontists, Oral Surgeons, Pediatric, Periodontists, Prosthodontists 1) You receive a 20% discount off the Specialist fee
2) Plan pays according to the Reasonable and Customary fees
3) Member pays the difference between plan payment and discounted Specialist fee 		Paid the same as non-contracted dentists 1) You receive a 20% discount off the Specialist fee
2) Plan pays according to the Reasonable and Customary fees
3) Member pays the difference between plan payment and discounted Specialist fee 		Paid the same as non-contracted dentists
Dental Rates

2023

Full Time

Part Time

  Monthly Monthly

Dental (2000)

Single $7 $13
Two party $18 $28.50
Family $24 $38

Dental Plus (2500)

Single $24 $34
Two party $57 $91
Family $78 $115
COBRA Rates

2023

COBRA

Dental 2000 (Cost per month)

Employee $34
Employee + 1 Child $77
Employee + Spouse $77
Employee + Children $102
Employee + Family $102

Dental Plus 2500 (Cost per month)

Employee $46
Employee + 1 Child $104
Employee + Spouse $104
Employee + Children $140
Employee + Family $140
Resources

Dental Select