Dental and Orthodontia Coverage

Dental

The Dental Plan is designed to help employees and their family members maintain good dental health through regular preventive care and assist in paying larger dental expenses.

• Fiscal Year Deductible: $25 per covered person
• Coinsurance: Plan pays 80%, Employees pay 20%
• Benefit Maximum: $1000 per person per fiscal year

Each year, employees must satisfy a fiscal year deductible. After that, when covered dental charges are incurred, the plan pays a percentage of the customary and reasonable charges up to the benefit maximum. Employees are responsible for the coinsurance payment (and any amount over the customary and reasonable charge).

Refer to page 14 of the Benefits Guide for your employment group for a listing of Covered Dental Expenses.

Dental and Orthodontia

You may choose Dental/Orthodontic coverage for yourself and/or your dependents. Orthodontia coverage includes Dental (as listed above) and Orthodontia (for the treatment of irregularities of the teeth such as alignment and occlusion, including the use of braces) as follows:

• Coinsurance: Plan Pays 50%, You Pay 50%
• Benefit Maximum: $1,000 Lifetime Maximum

The plan will pay 50% of covered expenses up to $1,000. This amount applies to each covered person separately, up to a lifetime benefit of $1,000. The Orthodontic Plan only covers expenses that begin after your coverage begins.

Refer to page 15 of the Benefits Guide for your employment group for a listing of Covered Orthodontic Expenses.

Premiums for dental or dental orthodontia are deducted on a pre-tax basis.