/ Human Resources

Dental Plans At a Glance

2017/18 in-network plans

  Plan 2/Basic Dental Plan 3/Dental with Ortho
deductible $50 per member, limited to $100 per family $50 per member, limited to $100 per family
class 1 services (preventive exams, cleanings, x-rays, etc.) 100% of approved amount within treatment limits 100% of approved amount within treatment limits
class 2 services (fillings, oral surgery, root canals, etc.) 75% of approved amount 75% of approved amount
class 3 services (12-month wait period) crowns, bridges, impants, etc.) 50% of approved amount 50% of approved amount
class 4 services (orthodontic services for dependents under age 19 — 12-month wait period) Not applicable 50% of approved amount
Dollar maximums
Class 1, 2 and 3: $1,000 per member
Class 4: NA

Class 1, 2 and 3: $1,000 per member
Class 4: $1,000 per member/1x lifetime
benefits at a glance Plan 2/Basic Dental Plan 3/Dental with Ortho
Employee premiums (per pay 2x/mth) Single: $14.87
Two-Person: $29.73
Family: $52.03
Single: NA
Two-Person: $30.47
Family*: $53.32