| Who Can Enroll |
Available to all active employees and their families as well as retirees* |
Available to all employees and their families (not available to retirees) |
| Maximum Annual Benefit |
$1,500 per covered individual |
$750 per covered individual |
| Preventive and Diagnostic Services |
Twice per year for:
- Initial and periodic oral exam
- Cleaning
- Bitewings
- Topical application of fluoride
One in five years
- Complete series of intraoral x-rays
|
Twice per year for:
- Initial and periodic oral exam
- Cleaning
- Bitewings
- Topical application of fluoride
One in five years
- Complete series of intraoral x-rays
|
| Basic Restorative Services |
Amalgam filling, root canal, endodontic and periodontic treatment |
Not covered |
| Major Dental Services |
Crown, complete lower and upper denture |
Not covered |
| Removal of Impacted Teeth |
Covered benefit |
Covered benefit |
| Orthodontia |
Available to covered children and adults ($1,500 lifetime benefit) |
Not covered |
| StarBaby Maternity Program |
You must be enrolled in the StarBaby program to receive additional benefits (see booklet for more information) |
You must be enrolled in the StarBaby program to receive additional benefits (see booklet for more information) |
