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Dental Plan

  • Description and Coverage

    The Dental Plan requires a minimum of 10 members. This Plan covers a wide variety of dental benefits, divided into four categories:

  • Type I - Preventive Treatment:

    • Two (2) oral checkups per year
    • Two (2) prophylaxes per year, including dental cleaning, scraping and polishing
    • Fluoride applications for children under 14
    • A complete series of X-rays every three years
    • Two (2) X-ray tests per year with bite-wing film holder
    • Lab tests and other diagnostic exams

  • Type II - Restorative Treatment:

    • Space maintainers
    • Temporary emergency treatment
    • Simple (routine) extractions
    • Surgical extractions
    • Oral surgery
    • Alveolectomy
    • Anesthesia
    • Therapeutic injections
    • Restoration:
      • Includes amalgam or synthetic process fillings
      • Excludes back or front crowns or fillings, initial installation of complete or partial denture, and replacement of denture or fixed bridge units
    • Endodontics
    • Periodontology

  • Type III - Major Services:

    • Inlays
    • Fillings
    • Crowns
    • Denture repair, bridges, and prosthesis
    • Restoration

  • Type IV - Orthodontics:

    • Includes accessories and appliances, any device necessary for treatment
    • Includes orthodontic treatment in accordance with a Treatment Plan submitted in writing to the Company within ninety (90) days before commencement of said treatment