DENTAL INSURANCE
Fast Track Urgent Care offers dental coverage through SunLife Financial, which is a Dental PPO Plan. This plans allow you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between SunLife’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plan.
PPO DENTAL PLAN
In-Network
Calendar Year Deductible
Individual
$50
Family
$150
Annual Maximum (pre covered member)
Per covered member
$1,000
Preventive Services Exams (2 in 12 months), Cleanings, & Fluoride
Covered in full
Basic Services
Fillings, Simple Extractions, Perio, Endo, & Periodontal Maintenance
Covered 90% after deductible
Major Services
Crowns, Bridges, Surgical Extractions, Root Canal, & Dentures
Covered 60% after deductible
Orthodontia (Child only through age 18)
50% up to $1,500 (Lifetime Max)
Out-of Network 1
Calendar Year Deductible
$50 / $150
Schedule of Services: Preventive
Covered 80% Covered 50% after deductible Covered 30% after deductible
Basic Major
Orthodontia
None
Annual Maximum (pre covered member)
$ 1,000
90 th Usual & Customary Charges
Basis of Payment
Semi Monthly Cost for Coverage
Employee Only
$13.82
Employee + Spouse
$27.29
Employee + Child(ren)
$44.05
Employee + Family
$57.52
1 Subject to balance billing. Please refer to your plan document for specific details.
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