The Premium and Basic Dental Plans are available to employees and spouses.
Dependent children are eligible for preventive services only.
If you elect the Premium Plan and have covered dependent children on this Plan, preventive services ONLY are covered for children. The Dental Plan will pay only the actual expense incurred for medically necessary covered dental procedures not to exceed the Maximum payment specified in the Dental Schedule. This is a Scheduled Benefit Plan and Participating Provider arrangements DO NOT apply. Covered dental charges are those charges specified in the Dental Schedule when performed by a duly licensed physician, dentist or licensed denturist operating within the scope of his or her license. Dental services must be for the treatment of accidentally injured or diseased teeth, or supporting bone or tissue.