Office of Human Resources - Benefits Design & Management

DENTAL

 

PRE-PAID PLANS
With a pre-paid plan you must choose a
primary dentist from a list of network dentists.
You will receive all dental care from that
dentist, paying a reduced fee for services.

There is no maximum annual limit, no deductible
and no claim forms. Orthodontia coverage is provided
at a reduced fee with no age limit; TMJ and
periodontal coverage also are included.

PRE-PAID
Assurant
Plan Description
Claim Form
1.800.443.2995

Employer Dental Services
Plan Description
1.800.722.9772
PPO INDEMNITY PLANS
With a PPO plan you have the freedom to go
to any dentist of your choice.

After a $50 single/$150 family deductible,
the plan pays either 80% of usual, reasonable and
customary charges (URC) for routine procedures or
50% for major restorative work up to $2000/plan year.
Orthodontia is paid at 50% URC with a
separate $1500 lifetime maximum/ participant.

PPO
Delta Dental
Plan Description
Claim Form
1.800.352.6132

 

Met-Life Dental
Plan Description
Claim Form
1.800.942.0854

  VISION

AVESIS, INC.
Vision coverage for you and your family is provided
through Avesis, Inc. You pay all premiums for the plan.

Benefits are provided once a plan year through either
a participating network provider or non-participating provider.

 Avesis,Inc.
Brochure
Benefits Summary
Claim Form

This information is not binding and subject to change at any time. Federal regulations, ABOR, ASU and ADOA policies and vendor contracts govern benefits eligibility and coverage. If there is any discrepancy between this information and the plan documents, the plan documents will govern.