The following chart provides a comparison of costs for certain procedures covered by the state-sponsored dental plans. Please consult each dental plan's Evidence of Coverage for detailed information and plan limitations.
Comparison of Dental Plan Benefits
| Who is Covered |
Represented Employees |
Dependents of Represented Employees |
Excluded Employees and Dependents |
Employees and Dependents |
Employees and Dependents |
| Diagnostic and Preventive Benefits (two cleanings annually) |
No charge* |
No charge* |
No charge* |
No charge** |
20% |
| Basic Benefits |
10% |
20% |
10% |
10%* |
20% |
| Crowns |
20% |
50% |
20% |
20%* |
50% |
| Bridges, Full & Partial Dentures |
50% |
50% |
50% |
40% |
50% |
| Implant Benefit |
N/A |
N/A |
N/A |
Will pay 50% up to a lifetime maximum of $2,500 |
Will pay 50% up to a lifetime maximum of $2,500 |
| Orthodontia |
Will pay up to 50% of approved fee for orthodontia, with a lifetime maximum for this benefit of $1,000 for adult |
Will pay up to 50% of approved fee for orthodontia, with a lifetime maximum for this benefit of $1,000 for dependent |
Will pay up to 50% of approved fee for orthodontia, with a lifetime maximum for this benefit of $1,000 for adults and dependent children |
Will pay up to 50% of approved fee, with a lifetime maximum of $1,000 for each adult and $1,500 for dependent children |
Will pay up to 50% of approved fee, with a lifetime maximum of $1,000 for each adult and dependent children |
| Annual Deductible |
$50* |
$50* |
$25* |
$25* |
$75 |
| Maximum Deductible |
$150 per family |
$150 per family |
$100 per family |
$100 per family |
$200 per family |
| Annual Maximum |
$2,000 |
$1,000 |
$2,000 |
$2,000 |
$1,000 |
*Diagnostic and Preventive Benefits are exempt from the deductible.
**The level of benefits and covered services reflected in the chart are based on services provided by a PPO Plan dentist; for services provided by a non-PPO plan dentist, the level of benefits is lower. Additionally, the PPO includes a 3rd cleaning for high-risk patients and a benefit for dental implants (up to $2,500 lifetime maximum).
