Silver Dental Plan
NO WAITING PERIODS
- Employees can select from all plans within a Group
- Gold & Platinum Plans pay Endodontics & Periodontics at 90%
- 24 hour access to your benefit information at www.healthedgeonline.com
- Ask about our Out of Network UCR Option
|
Silver | Benefits |
| Calendar Year Maximum (3 Per Family) |
$1,000 | |
| Calendar Year Deductible | $50 | |
| Preventative Services No Waiting Period |
100% | Exams – 2 per calendar year Cleanings – 2 per calendar year Bitewing X-rays – 2 per calendar yr Fluoride – 1 per calendar year to age 16. |
| Basic Services No Waiting Period |
50% | Simple Extractions Fillings Space Maintainers Diagnostic X-rays Oral Surgery Endodontics (Root Canal) Periodontics, Nightguards, Scaling 1 per quadrant every 6 months |
| Major Services No Waiting Period |
50% | Bridges Dentures Crowns Sealants to age 16 - $50 calendar year maximum |
| Orthodontic Services No Waiting Period Calendar Year Maximum Lifetime Maximum |
Not Covered | Straightening of Teeth Dependent children to age 19 only |
- Prior extractions not covered unless it includes replacement of a natural tooth lost or extracted while covered under this plan. Limitation ends after covered under this policy for 36 consecutive months.
- Unmarried dependent children are covered from age 19 until their 23rd birthday, if enrolled as full-time students
- Prosthetic replacement – one time every 5 years.
THIS FORM IS A SUMMARY OF PLAN BENEFITS ONLY –
REFER TO BENEFIT ERTIFICATE FOR COMPLETE BENEFIT DETAILS
INCLUDING LIMITATIONS AND EXCLUSIONS.
HealthEdge Administrators is a wholly owned subsidiary of the Foundation for Medical Care of Kern and Santa Barbara Counties. Established in 1959, the Foundation represents one of the largest PPO Networks in California and Administers Self-Funded Medical and Dental Plans for Employers, Counties and Government Entities. HealthEdge Administrators provides service within the state of California.
HealthEdge Administrators is not affiliated with Healthedge Software, Inc. to visit Healthedge Software’s website: www.healthedge.com
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