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Faculty & Staff

Risk & Benefits Management

Dental Benefits

Deductible does not apply

The Plan will pay reasonable and customary fees of licensed dentists up to a maximum of $1,200 per calendar year per person on the following basis:

Payable at 80%

  • Oral exams, prophylaxis (cleaning and polishing), and bitewing x-rays twice per calendar year (January 1 – December 31)
  • Full mouth x-rays once in any consecutive 24-month period
  • Emergency treatment
  • Topical fluoride applications (to age 19)
  • Endodontics, including pulpotomy, pulp capping and root canal therapy
  • Denture repair and relining, and re-cementing of inlays, on-lays and crowns
  • Extractions, dental tests, oral surgery and related anesthesia
  • Fillings consisting of amalgam, silicate and plastic restorations, and sealants
  • Space maintainers
  • Periodontics (diseases of the gum) and apicoectomy

Payable at 50%

  • Gold foil restorations, inlays and on-lays, and crowns and crown buildup
  • Dentures, full and partial
  • Bridges, fixed and removable
  • Orthodontics (to age 19)

The date you take possession of a dental appliance will be the date the expense is incurred. The Plan will not pay for lost or misplaced dentures, cosmetic dentistry, implants or bridges involving dental implants; the placement of crowns, inlays and on-lays, bridges and dentures or the relining of dentures more than once per consecutive five-year period for the same tooth or teeth; general anesthesia for three or less simple extractions; hospital charges for out-patient surgery for the removal of impacted teeth, unless pre-approved by the Claim Administrator, or charges of a dentist except as set forth above.