Dental Coverage

Coverage to Smile About

You will definitely have something to smile about when you enroll in our dental plan. Experience great benefits, national coverage and affordable rates:

• Coverage ranges from basic preventive care to crowns, bridges and orthodontia.
• Vast provider selection-over 120,000 dental PPO locations nationwide.
• No claim forms to file-PPO dentists do it for you!
• Benefits that increase the longer you are enrolled.
• Affordable rates and a special rate category for people who need Self Plus One coverage.

• Locate Dental PPO Providers

Benefit Details

Summary Of PPO Dental Benefits

Topic	Calendar Year Deductible	First Year (1st-12th month of coverage)	Second Year (13th-24th month of coverage)	Third Year (24th month of coverage)
Preventive Care Exams, cleanings (twice annually) , and bitewing x-rays	No deductible	100%	100%	100%
Basic Services: Fillings, extractions, and x-rays	$50 per person Up to $150 per family	70%	80%	80%
Major Services: Root canals, crowns and bridges	$50 per person Up to $150 per family	Benefits begin in second year	50%	50%
Orthodontia (children 18 and under, $1000 lifetime benefit maximum)	$50 per person Up to $150 per family	Benefits begin in third year	Benefits begin in third year	50%

The annual deductible ($50 per person, $150 per family) applies to Basic and Major services.  The annual benefit maximum of $1,000 per person and $3,000 per family will change for 2012 to $2,000 per person per calendar year, subject to each state's approval.  Coverage will not begin without payment of premium.

* © 2011 Coventry Health Care. All rights reserved. All other names and (registered) trademarks are the property of their respective owners. Dental and vision coverage provided by First Health Life & Health Insurance Company, Cambridge Life Insurance Company or Vision Service Plan, Inc. These benefits are neither offered nor guaranteed under contract with the FEHBP, but are made available to all FEHBP participants and their covered family members. You cannot file a FEHBP disputed claim about them. The fees you pay for these services do not count toward FEHBP deductibles or out-of-pocket maximums.  See Certificate of Insurance for full coverage details, exclusions and limitations. For dental coverage, annual deductible applies ($50 per person, $150 per family). The annual benefit maximum for dental coverage will be $2,000 per person per calendar year in 2012, subject to each state’s approval. Coverage will not begin without payment of premium. Your coverage is renewable as long as your premiums are paid and the Master Group Policy remains in force, and you remain eligible for this coverage. The dental PPO network is made available by The Guardian Life Insurance Company of America.  Benefits are not provided for services rendered outside the 50 United States and the District of Columbia.

** You do not have to be enrolled in a MHBP health plan to enroll in the MHBP Dental or Vision Plans. However, a single annual $42 MHBP associate membership fee makes the dental and/or vision plans available to you.