Population: New or Prospective Non-Represented
Your Coverage Options
Your Dental Benefits Program options generally cover the same types of dental services. In addition, the Dental/Vision option, also covers vision care expenses. The following options are available:
- No Coverage
- Dental Freedom of Choice (FOC) Option
- Dental/Vision Option
- Basic Dental and Basic Dental CT Options
- Dental Maintenance Organization
(DMO) Option
No Coverage
If you choose No Coverage, you're confirming that you have coverage elsewhere. You’ll receive a credit as cash back in your paycheck.
Dental Freedom of Choice (FOC) Option
The FOC option has an in-network plan (also called the DMO) and an out-of-network plan (also called the PPO). This option works differently than most dental options. You enroll for either in-network or out-of-network benefits. You cannot receive out-of-network benefits if you are enrolled for in-network benefits and vice-versa. The plan you choose applies to all covered individuals. For example, if you enroll for in-network benefits, all of your covered dependents are also enrolled for the in-network benefits. If one of your dependents visits an out-of-network provider, services are not covered. However, you can switch at any time, and the change applies to all covered individuals.
If you change from one to the other by the 15th of the month, the change takes effect the first of the following month. If you change from one to the other after the 15th of the month, the change doesn't take effect until the first of the second month.
- You decide whether to enroll yourself and your covered dependents for in-network (DMO) benefits or out-of-network (PPO) benefits.
- If you choose in-network DMO benefits, you must receive care from a dentist participating in the DMO Managed Care Network. There is no deductible, and services are covered at a higher level.
- If you choose out-of-network PPO benefits, you can receive care from a dentist of your choice. There is a $100/$200 family deductible to meet before services are reimbursed.
- You have the opportunity to save money by using a dentist who participates in the Preferred Provider Organization (PPO). These dentists have agreed to negotiated fees that may be less than their normal fees.
Quick Reference
Coverage Schedule
| Services | DMO (In-Network) | PPO (Out-of-Network, after deductible) |
|---|---|---|
| Diagnostic and Preventive | 100% | 100% (not applied to deductible) |
| Restorative | 60% - 80% | 50% |
| Oral Surgery/Periodontics/Endodontics | 60% - 80% | 50% |
| Prosthodontics | 60% | 50% |
| Orthodontics for Children (orthodontic appliance must be in place before the eligible dependent's 19th birthday) |
50% | 50% |
| Maximums | No maximum benefit | $750 annual maximum (per participant) $1,000 lifetime maximum orthodontia (per eligible child) |
Is this option for me?
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Dental/Vision Option
The Dental/Vision option provides coverage for both dental and vision care up to a combined maximum of $1,750 of eligible expenses for a family. For your dental care, you have the freedom of choosing your own dentist; or, you can choose to receive care through a Preferred Provider Organization (PPO) dentist. If you use a PPO dentist, your expenses will be lower.
This option reimburses you:
- For 100% for the first $250 of family covered expenses.
- For 80% of the next $1,500 of family covered expenses
- A maximum of $300 per family, per year for covered vision expenses.
- A maximum total annual reimbursement of $1,450 per year for combined eligible dental and vision expenses of $1,750 per family.
Note: An orthodontic appliance must be in place prior to an eligible dependent’s 18th birthday to be eligible for coverage.
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Basic Dental and Basic Dental CT Options
With this option, you have the freedom to choose any dentist. You receive coverage for a wide range of services, and the level of reimbursement depends on the type of care you receive. However, depending on the services you need, you could pay higher out-of-pocket costs than some other options. But, if you choose to receive care through a Preferred Provider Organization (PPO) dentist, your expenses will be lower.
Quick Reference
The plan pays:
- 100% for preventive and diagnostic services.
- 80% for restorative services.
- 50% for oral surgery, periodontics, endodontics, and prosthodontics.
Annual maximum benefits:
- $1,700 per person (not including orthodontic benefits).
- 50% of expenses for orthodontics, up to $1,700, for each eligible dependent child per lifetime.
- To be eligible for coverage, an orthodontic appliance must be in place prior to an eligible dependent's 18th birthday.
You’ll need a pre-treatment review for dental work that is expected to cost more than $350.
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Your Options!
Dental Maintenance Organization (DMO) Option
With this option, you can receive care from dentists who participate in the DMO Managed Dental Network. When you receive care in-network, most of your expenses are paid by the DMO, but you may be required to pay a portion of the cost for some services. If you receive care out-of-network, your expenses are not covered.
Quick Reference
This option reimburses you:
- 100% for preventive and diagnostic services and most restorative services;
- 60% for selected major restorative services; and
- 50% for orthodontics for dependents. There is an out-of-pocket limit of $1,250 per eligible dependent and benefits are limited to one course of treatment per lifetime.
Note: an orthodontic appliance must be in place prior to an eligible dependent's 19th birthday to be eligible for coverage.
Is this option for me?
Compare your options!
Before choosing a coverage option, consider the cost of each option.
For a more detailed description of your dental benefits, the Dental Benefits Program section of the Benefits 2000 Non-Represented summary plan description.