Home Medical Dental Downloads Plan Summary Claim Form Contact Sheet Resources Dental Insurance Company Website Find a Dentist Oral Health Resources Forms Library Vision Life Disability Retirement FSA Supplemental Wellness Enrollment Customer Service Dental Insurance Company (800) 555-1111 Have Questions? Contact Us Benefit Associates, LLC 1501 South Alexander Street, Suite 104 Plant City, FL 33565 (813) 719-3937 www.benefitassociatesllc.com	Dental insurance is provided by Dental Insurance Company. Dental is a voluntary benefit, paid 100% by the employee. Low Plan High Plan Applies to basic and major services Applies to basic and major services Individual: $150 $150 Family: $250 $250 Calendar Year: $1500 $1500 Orthodontic Lifetime: $1500 $1500 Preventive Procedures: In-Network: 100% Out-of-Network: 60% Diagnostic (x-rays, oral exams), preventive (cleanings, fluoride treatments, sealants), other covered services. In-Network: 100% Out-of-Network: 70% Diagnostic (x-rays, oral exams), preventive (cleanings, fluoride treatments, sealants), other covered services. Basic Procedures: In-Network: 60% Out-of-Network: 50% Restorative (fillings), oral surgery (extractions), periodontics (gum and bone), endodontics (root and pulp), prosthetic maintenance, other covered services In-Network: 70% Out-of-Network: 60% Restorative (fillings), oral surgery (extractions), periodontics (gum and bone), endodontics (root and pulp), prosthetic maintenance, other covered services Major Procedures: In-Network: 30% Out-of-Network: 20% Prosthodontic (teeth replacement, dentures, fixed bridges and crowns), major restorative (crowns), other covered services In-Network: 40% Out-of-Network: 40% Prosthodontic (teeth replacement, dentures, fixed bridges and crowns), major restorative (crowns), other covered services Orthodontics: In-Network: 50% Out-of-Network: 50% In-Network: 50% Out-of-Network: 50% To Enroll: To enroll in this plan, use the "Dental Enrollment Form" located on the enrollment tab. To enroll in this plan, use the "Dental Enrollment Form" located on the enrollment tab. Low Plan Rate Structure* Single $10.85 Single + Spouse $16.99 Single + Child $19.34 Family $28.69 High Plan Rate Structure* Single $15.61 Single + Spouse $25.65 Single + Child $35.86 Family $48.89 Note: * Employee Cost Per Pay Period
This site provides a brief summary of your plans; it is not a contract. Please see insurance contracts (available from Human Resources) for complete policy details and limitations.