Dental Coverage

The plan requires that a deductible is met before a benefit is paid. A deductible is the amount a member must pay for eligible expenses before the plan begins to pay benefits.

The plan requires that a deductible is met before a benefit is paid. A deductible is the amount a member must pay for eligible expenses before the plan begins to pay benefits.

This dental plan does not cover all dental care expenses and has exclusions and limitations. You should refer to your certificate to determine which dental care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered. However, your plan may contain exceptions to this list based on state mandates or the plan design purchased.

1. Cosmetic procedures unless needed as a result of injury.
2. Any procedure, service or supplies that are included as covered medical expenses under
   another group medical expense benefit plan.
3. Prescribed drugs, pre—medication, analgesia or general anesthesia.
4. Services provided for any type of temporomandibular (TMJ) or related structures, or myofascial pain.
5. Charges in excess of the Recognized Charge, based on the 80th percentile of the FAIR Health RV Benchmarks.