Dental
Dental coverage helps you maintain a healthy smile with preventive care, basic services, and major procedures. You can visit any licensed dentist, but you’ll save the most when you use an in-network provider who has agreed to discounted rates. Out-of-network dentists may charge more than the plan’s allowed amount, and you may be responsible for the difference. Most plans cover preventive services—such as exams, cleanings, and X-rays—at 100% when you stay in-network, making regular checkups an easy way to protect your oral health and avoid costly issues.
High Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,500
Annual Plan Max (Individual/Family)
$50/$150
Preventive Care
$0
Basic Services
20%*
Major Procedures
50%*
Orthodontia (Adults and Children up to age 19)
50% up to a lifetime maximum benefit of $1,500 per individual; deductible waived
* After deductible
Out-of-Network
Deductible (Individual/Family)
$XX
Annual Plan Max (Individual/Family)
$XX/$XX
Preventive Care
$0
Basic Services
XX%
Major Procedures
XX%
Orthodontia (Adults and Children)
XX% up to a lifetime maximum benefit of $XXX per individual; deductible waived
Weekly Plan Cost (Hourly Employees)
Employee Only: $5.72
Employee and Spouse: $10.75
Employee and Child(ren): $13.35
Employee and Family: $19.71
Bi-weekly Plan Cost (Salaried Employees)
Employee Only: $11.45
Employee and Spouse: $21.51
Employee and Child(ren): $26.70
Employee and Family: $39.42
DHMO Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
Unlimited
Annual Plan Max (Individual/Family)
N/A
Preventive Care
Copays vary
Basic Services
Copays vary
Major Procedures
Copays vary
Orthodontia (Adults and Children)
Copays vary
Out-of-Network
Deductible (Individual/Family)
$XX
Annual Plan Max (Individual/Family)
$XX/$XX
Preventive Care
$0
Basic Services
XX%
Major Procedures
XX%
Orthodontia (Adults and Children)
XX% up to a lifetime maximum benefit of $XXX per individual; deductible waived
Weekly Plan Cost (Hourly Employees)
Employee Only: $2.59
Employee and Spouse: $4.48
Employee and Child(ren): $5.03
Employee and Family: $7.19
Bi-weekly Plan Cost (Salaried Employees)
Employee Only: $5.17
Employee and Spouse: $8.96
Employee and Child(ren): $10.06
Employee and Family: $14.38