Dental Coverage
Taking care of your teeth is as important as taking care of the rest of your body. Some medical problems, such as diabetes and cardiovascular disease, may be linked to oral health. To maintain good oral health, you should brush your teeth at least twice a day, replace your toothbrush every three to four months, floss daily, and schedule regular dental checkups.
Our dental plan helps you maintain good dental health through affordable options for preventive care including regular checkups and other dental work. Premium contributions for dental will be deducted from your paycheck on a pre-tax basis. Your tier of coverage will determine your total premium.
Dental PPO
If you enroll in the SAMPLE Dental PPO plan, you still have the ability to choose any dental provider; however, if you choose a participating SAMPLE provider, your out-of-pocket costs will be less. When a nonparticipating provider is chosen, you may be subject to balance billing (the difference between what your provider charges and what SAMPLE provider will reimburse). To access a current provider directory, please visit SAMPLE provider’s website at www.SAMPLE.com.
| DPPO (Radius Network) | DHMO Network | ||
|---|---|---|---|
| IN-NETWORK | OUT-OF-NETWORK | IN-NETWORK ONLY | |
| Calendar Year Deductible | |||
| Individual | $50 | $50 | Not Applicable; $5 Copay Per Office Visit |
| Family | $150 | $150 | |
| Calendar Year Maximum Benefit | $1,000 Per Individual | Per Schedule | |
| Preventive Care (Cleanings, Oral Examinations, Fluoride Treatments, etc.) | 100% | 100% | Scheduled Fee |
| Basic Care (Fillings, Simple Extractions, Root Canals, etc.) | 80%* | 80%* | Scheduled Fee |
| Major Care (Crowns, Inlays, Bridges, etc.) | 50%* | 50%* | Scheduled Fee |
| Orthodontia | |||
| Coverage | children only up to age 19 | adults and children | |
| Benefit | 50%* | 50%* | Scheduled Fee |
| Lifetime Maximum | $1,000 | Per Schedule | |
| * After Deductible | |||