Dental Plan Comparison (2008)
Duke offers you a choice of two plans, depending on the level of coverage you and your family may need. Both
plans cover preventive, basic, and major services, but they differ in how they pay for covered services.
Annual Benefit for Preventive, Basic, and Major Covered Services
(does not include orthodontia) |
$1,000 per person1 |
$750 per person1 |
Preventive:
coverage of all below applies to Plan A and Plan B |
 2 exams per year
2 cleanings per year
Space maintainers
X-rays
Fluoride treatments
(for children under age 19)
|
Covered in full up to U&C2, no deductible |
Pays a predetermined fixed amount based on procedure received |
Basic:
coverage of all below applies to Plan A and Plan B |
Fillings
Sealants
Full or partial denture repair
Anesthesia for oral surgery
Periodontal or gum treatment
Removal of teeth
Root canals |
After $100 lifetime deductible per person:
80%
of U&C2 during first year of coverage
90%
of U&C2 during second year of coverage if an exam is received during the first year
100%
of U&C2 thereafter if an exam is received in second and following years
|
Pays a predetermined fixed amount based on
procedure received, after combined basic and major $50 calendar year deductible per person |
Major:
coverage of all below applies to Plan A and Plan B |
Crowns
Bridgework
Partial or full dentures
Dentures, prosthodontics, and inlays |
$50 calendar year deductible
per person, then 50% of U&C2 |
Pays a predetermined fixed amount based on procedure received,
after combined basic and major $50 calendar year deductible per person
|
Orthodontia:
coverage of all below applies to Plan A and Plan B |
Benefits
payable only if treatment begins after the participant becomes covered by the Duke Dental Plan |
50% of U&C2, no deductible
$1,000 lifetime
orthodontia maximum
benefit per person (adults and children) |
50% of U&C2, no deductible
$750 lifetime orthodontia maximum benefit per person (adults and children) |
-
Dental plan members who visited the dentist and had at
least one dental claim filed in calendar year 2007, with less than $500 in
claims payments, will have their annual maximum benefit increased by $250 in
2008. This accumulation can continue until the annual maximum has increased on
Plan A from $1,000 to $2,000, or on Plan B, from $750 to $1,750.
-
All payments are based on the usual and customary (U&C)
allowable charge. You are liable for charges over U&C.
|
