ABC Company’s dental plan is designed to encourage preventive dental care, providing benefits for services that are essential to good oral health. Good dental health can have an impact on overall health and can indicate signs of more serious health issues.

You may use any provider you choose, but you will generally save money if you use a dentist in-network. Network dentists have agreed to charge negotiated rates for services. To find a network dentist, visit or call 123-1234.

Dental Plan Highlights

  • The plan allows two preventive dental visits each calendar year.
  • The cost of your cleanings is covered under preventive care and is not subject to the deductible or counted against your total calendar year maximum.
  • Expectant mothers will be covered for three cleanings in one calendar year during pregnancy, rather than two.
  • Composite fillings are covered at 70% for all teeth, and dental implants are covered at 60% (subject to calendar year maximum).

See the chart below for more detailed information:

Plan Provisions In-Network Out-of-Network
Calendar year deductible for basic and major services $50 individual / $150 family $50 individual / $150 family
Preventive services – one routine exam and cleaning every six months Plan pays 100%
(no deductible)
Plan pays 100% of allowable charges
Basic services – fillings and extractions Plan pays 90% Plan pays 80% of allowable charges
Major services – root canals, crowns, inlays, prosthodontics and oral surgery Plan pays 60% Plan pays 50% of allowable charges
Annual maximum for preventive, basic and major services $2,250 per person $2,250 per person
Orthodontia for children up to age 19 Plan pays 50% up to $1,000 lifetime maximum per person Plan pays 50% up to $1,000 lifetime maximum per person

Your Cost for Coverage

The below table displays the monthly cost for coverage for you and your family.

Dental Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
PPO $15 $30 $35 $50