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Important:
If you and or any dependents under the age of 19 are enrolled in the Student Health Insurance Plan, they will be automatically covered for pediatric essential dental benefits as part of the medical plan. Review the Pediatric Essential Dental Benefits for more information. The “Pediatric Essential Dental Benefit” will end on the last day of the month in which you (and any dependents enrolled in the medical plan) turn 19. This life-changing event allows you the option to enroll in one of the optional dental plans noted below. Enrollment is time-sensitive; you have 60 days from the last day of the month in which you turned 19 years old to enroll in an optional plan noted below. Example: If you or an enrolled dependent turn 19 on April 5th, the Pediatric Essential Dental Benefits will end on April 30th. You will have 60 days from April 30th to enroll in one of the two optional dental plans if you want to participate.
Optional Dental Plans
| Dental Blue Preventive | Dental Blue Comprehensive |
|---|---|
| This plan only provides coverage for diagnostic and preventive care, such as routine cleanings. If you need other care, such as fillings and root canals, you’ll be responsible for paying the full cost of those services. | This is a good option if you want the most dental protection. In addition to diagnostic and preventive care, you’ll receive additional coverage for basic and major services, such as fillings, crowns, and root canals. |
| $ | $$ |
| Key Features – Pays 100 percent of diagnostic and preventive care with participating dentists – No deductible – $500 plan year benefit maximum – Access to full Dental Blue dentist network | Key Features – Pays 100 percent of diagnostic and preventive care, 60 percent of basic services, and 40 percent of major services with participating dentists – $50 deductible/individual plan; $150 deductible/family plan (Basic and Major services only) – $1,500 plan year benefit maximum – Access to full Dental Blue dentist network |
Benefits and Coverage
| Preventive Plan | Comprehensive Plan | |
|---|---|---|
| Plan Year Maximum | $500 | $1,500 |
| Diagnostic Type 1 Benefits | 100% coverage | 100% coverage |
| Preventive Type 1 Benefits | 100% coverage | 100% coverage |
| Basic Type 2 Benefits | 60% after deductible | |
| Major Type 3 Benefits | 40% after deductible |
