Participating dentists
Documents
Plan Document
Summary Plan Description
Enrollment Form
Waiver Form
Dental Rates 2021
Dental Insurance
Premiums
The diocese pays the full cost for employee dental coverage. Employees may purchase family dental insurance for spouses and eligible dependents. The cost for family dental insurance is paid by the employee through payroll deduction.
These rates are for the 2021 calendar year.
Services covered
Covered charges are based on usual, customary and reasonable billed rates and consist of the types of services listed below:
- Diagnostic Services are paid at 100 percent with no deductible.
- Preventative Services are paid at 100 percent with no deductible.
- Basic Restorative Services are paid at 80 percent (fillings)
- Major Restorative Services are paid at 50 percent (crowns, inlays, onlays(excludes resin onlays)
- Oral Surgery services are paid at 80 percent (extractions/pre and post-operative care)
- Endodontics are paid at 80 percent (root canal, pupal therapy)
- Surgical and Non-Surgical Periodontics and are paid at 80 percent (surgical treatment of gums, etc.)
- Prosthodontics are paid at 50 percent (replacement of missing teeth, construction of bridges, etc.)
- General Anesthesia and IV sedation are paid at 80 percent (in conjunction with other procedures)
Limits and exclusions
- The maximum annual deductible paid for employee coverage in a calendar year is $25.
- The maximum annual deductible for family coverage in a calendar year is $75.
- The diocese’s dental insurance plan will pay a maximum of $1,500 per covered person in a calendar year.
Declining coverage
You may decline the diocese’s dental coverage. If you decline it for yourself, you are also declining coverage for your family members. Declining the dental coverage does not result in a payment or increase in your salary in lieu of coverage.
How to use this benefit
Make an appointment with an approved provider and they take care of the rest.
Enrolling and making changes
You should enroll, and select dependent coverage options, within 30 days of your start date. This initial enrollment typically happens during orientation.
Each fall, the diocese participates in open enrollment when you can make changes to your plan, like adding a spouse or dependent.
Outside of the open enrollment period, changes can only be made due to qualifying life events (like marriage, divorce or having a child). For more information, contact human resources.
| Documents |
| Option 7 Summary of Benefits |
| Insurance Plan |
| Forms |
| Enrollment Form |
| Waiver of Group Dental Benefits |