Benefits At a Glance
Feature | Description |
---|---|
Deductible | $50 Individual $150 Family |
Annual Maximum Benefit | $1,500 per insured |
EBMS is the third party administrator for the County’s Dental Plan.
There is not a network of dentists for the County’s Dental Insurance plan. You may use any dentist of your choice.
Rates
Coverage | Rates |
---|---|
Employee | $21.08 |
Family | $48.52 |
Late Entrant Penalty
Basic, Major Services and Orthodontic Services have a 24 month waiting period for late entrants. Late entrants are employees or dependents who do not apply for coverage when first eligible, then apply at a later date.
Preventative Services
Paid at 100% with No Deductible
- Routine Oral Exams – Limit 2 per year
- Prophylaxis – Limit 2 per year
- Dental X-Rays – Limit Full Mouth one every 3 years
- Bitewing X-rays Limit 2 per year
- Fluoride Treatments for Children under age 15 only
- Sealants – Ages 6 to 18 only – Limit of one per tooth every three years
- Diagnostic Casts
- Pulp Vitality Testing – One per year
Basic Services
Paid at 80% after deductible
- Simple Extractions
- Fillings – Silver amalgam & tooth colored materials
- Oral Surgery – Limited (See Medical & Dental Plan Booklet & obtain per- determination)
- Palliative Emergency Treatment – One visit per occurrence
- Occlusal Guards – Limited to one per lifetime
- Periodontics Services – treatment of disease of the tissue and bone structures supporting teeth
- Periodontal Prophylaxis – not to exceed 2 per calendar year combined with those provided under Preventive/Diagnostic prophylaxis benefits
- Endodontic – prevention/treatment of diseases of the dental pulp and surrounding periapical structures
- Other Visits and Exams
Major Services
Paid at 50% after deductible
- Inlays & Crowns
- Dentures – full and partial
- Dentures – including Rebasing or Relining
- Bridges – fixed and removable
- Repair of Fixed Bridges
- Repair of Removable Dentures
- RE-cement Crowns and Bridges
Orthodontic Services
Paid at 50% after deductible
- Only applies to dependents up to age 19
- Lifetime maximum benefit of $1,000
Certificate of Coverage
Review the Plan Document and Summary Plan Description for Medical & Dental plan details.
Dental starts on page 60 of the SPD.