Dental Coverage
Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower.
Keeping your teeth and gums clean and healthy will prevent most tooth decay and periodontal disease, and is an important part of maintaining your medical health.
Your PPO dental plan is through Sun Life and offers “in and out-of-network” benefits.
Please see chart below for information on waiting periods for dental work.
Insurance Carrier:
Sun Life Dental Insurance
Plan Type:
Basic Plan
Enhanced Plan
Calendar Year Deductible Calendar Year Maximum
$50 Individual / $150 Family
$50 Individual / $150 Family
$1,000
$2,000
Preventive Services
100%
100%
Basic Services Major Services
80% 50% 50%
90% 60% 90%
Endo/Perio
Orthodontic Lifetime (dependent children only) Important information
N/A
$2,000
Out-of-Network Reimbursement Employee Bi-Weekly Deduction Employee Only
90th UCR
90th UCR
8 We will not pay for treatments subject to the late entrant limitation, and started or completed during the late entrant limitation period. Teen Challenge 2022 Enrollment Guide TIME INSURED CONTINUOUSLY UNDER THE POLICY BENEFITS PROVIDED FOR ONLY THESE SERVICES Less than 6 months Preventive Services At least 6 months but less than 12 months Preventive Services and fillings under Basic Services At least 12 months Preventive, Basic, Major and Ortho Services $11.58 $22.81 Benefit adjustments Benefits will be coordinated with any other dental coverage. Under the Alternative Treatment provision, benefits will be payable for the most economical services or supplies meeting broadly accepted standards of dental care. Late entrant If you or a dependent apply for dental insurance more than 31 days after you become eligible, you or your dependent are a late entrant. The benefits for the first 12 months for late entrants will be limited as follows: $18.67 $36.55 Employee + Spouse Employee + Child(ren) $32.84 $44.07 $47.99 $65.88 Family
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