| Dental Benefits Summary | ||||||||||
| Buy-Up Plan | ||||||||||
| Calendar year maximum, per member | $1,500 | |||||||||
| Calendar year deductible, per member | $50 | |||||||||
| Calendar year maximum deductible, per family | $150 | |||||||||
| - | Oral Surgery (surgical extractions & certain minor surgical procedures) | |||||||||
| - | Endodontic (pulp therapy & root canal filling) | |||||||||
| - | Periodontics (treatment of tissues supporting the teeth) | |||||||||
| MAJOR (12 month waiting period applies) | 50% | |||||||||
| - | Crowns | |||||||||
| - | Cast Restorations | |||||||||
| - | Denture and Bridge Work (construction or repair of fixed bridges, | |||||||||
| partials, and complete dentures) | ||||||||||
| There is a 12-month waiting period before the Plan will pay for covered Class III Services. However, if you had dental coverage within 63 days prior to enrolling onto this Plan, credit will be given for each month of prior coverage. |
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