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Actives 2024 Effective Date
3/1/2024
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Retirees 2024 Effective Date
1/1/2024
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Class I - Preventive (exams, cleanings, x-rays, etc.)
100% †
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Class II - Basic (fillings, repairs, etc.)
90% †
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Class III - Major (bridge, dentures, root canals, oral surgery, etc)
75% †
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Class IV - Specialty Care (oral surgery, endodontics,periodontics,pedodontics)
50%
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Deductible
None
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Primary Care Maxiumum
$3,000
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Orthodontic Maximum (Lifetime)
$3,000 Up to age 19, $1,800 Adults 19+ Comprehensive Case Only
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Provider Directory
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2024 Benefit Summary
† PERCENTAGES are APPROXIMATE, see benefit breakdown as listed on the Benefit Summary.