Dental

What Is Covered

The plans pay for many of the preventive, basic and major services you and your family receive. The following services are covered under each plan:

Preventive Services

• Routine oral exams twice a year
• Teeth cleaning twice a year (including scaling and polishing for covered members age 14 and over)
• Fluoride application for dependent children to age 18 once a year
• Bitewing X-rays twice a year
• Full mouth series or panoramic X-rays once every three years

Basic Services

• X-ray and pathology
• Space maintainers
• Non-surgical extractions
• Oral surgery
• General anesthetics in connection with covered dental services
• Periodontics, endodontics, and root canals for impaired teeth only (excluding final restoration)
• Restorative dentistry including fillings, pins, stainless steel crowns, denture repairs, adding teeth to partial dentures (that replace natural teeth), recementation, and repairs to bridges and crowns
• Treatment of diseased periodontal structures
• Endodontic treatment. This includes root canal therapy.
• Injection of antibiotic drugs.
• Repair or recementing of crowns, inlays, bridgework or dentures.
• Relining of dentures

 

Major Services

• Replacement of an existing removable denture or fixed bridgework by a new denture, or the adding of teeth to a partial removable denture*
• Inlays, gold fillings or crowns. This includes precision attachments for dentures
• First installation of fixed bridgework to replace one or more natural teeth extracted while the person is covered. This includes inlays and crowns as abutments
• Replacement of an existing removable denture or fixed bridgework by new fixed bridgework, or the adding of teeth to existing bridgework*

* The following Prosthesis Replacement Rule must be met: (a) The replacement or addition of teeth is required to replace teeth extracted after denture or bridgework was installed (extraction must have been covered under Plan); (b) The denture or bridgework (must be 5 or more years old) cannot be made serviceable; (c) The denture must be an immediate temporary one to replace natural teeth extracted while you are covered and cannot be made permanent; and (d) Replacement by a permanent denture must be needed. Replacement must take place within 12 months from the date the immediate temporary one was first installed.