PESG Dental Benefits
Below you will find the benefits for our Dental Insurance program along with their applicable rates. If you need to view/print an application then please click here.
Type
I - Preventative Services ($50 deductible* - combined with Basic / No Waiting Period) |
|
| Oral
Exams |
Covered
- 80% |
| Teeth
Cleaning |
Covered
- 80% |
| Sealants
- for children |
Covered
- 80% |
| Flouride
Treatment - for children |
Covered
- 80% |
| Space
Maintainers - for children |
Covered
- 80% |
| Type
I - Basic Services
($50 deductible* / 6 Month Waiting Period**) |
|
| Laboratory
|
Covered
- 80% |
| X-Ray
|
Covered
- 80% |
| Extractions
|
Covered
- 80% |
| Fillings
- Amalgams, Acrylic, Composite Resin |
Covered
- 80% |
| Emergency
Exams |
Covered
- 80% |
| |
|
| Type
II - Major Services
($50 deductible* - combined with Basic / 12 Month Waiting Period**) |
|
| Bridge
Work & Crowns |
Covered
- 50% |
| Gold
& Porcelain Crowns |
Covered
- 50% |
| Periodontics
|
Covered
- 50% |
| Endodontics
|
Covered
- 50% |
| Oral
Surgery |
Covered
- 50% |
| Orthodontic
Services |
Not
Covered |
| Maximum
Annual Benefit Per Individual |
$750.00
|
| Monthly
Dental Prices |
|
Single: |
$21.29 |
Double: |
$50.35 |
Family: |
$60.99 |