The DentalCom Plan has no yearly dollar maximum or deductible.
The following dental care services are covered at 100% except as noted otherwise:
- Routine oral examinations and prophylaxis (cleaning of teeth) once every 6 months per covered individual.
- Dental x-rays including full mouth x-rays once every 5 years, supplemental bitewing x-rays once every 6 months and such other dental x-rays as are needed for diagnosis and treatment of a specific condition.
- Topical fluoride treatment.
- Space maintainers that replace prematurely lost primary teeth.
- Oral hygiene, plaque control and dietary instruction.
- Topical application of sealants. Application is limited to the occlusal surface of permanent molars which are free of caries and restorations. Benefits are limited to one (1) application per lifetime.
- Initial placement of sealants on posterior permanent teeth within two (2) years of their eruption. Replacement of sealants shall be covered until the age of 18.
The following dental care services are covered at 90% except as noted otherwise*:
Patients should check with the Patient Accounts staff prior to the appointment, or the cashier on the day of the appointment at the Dental Clinic of Marshfield, S.C. regarding fees due. Fees must be paid in full on the date services are received.
- General anesthetics when medically necessary (your personal physician must verify in writing that your health history makes a general anesthetic necessary) and administered in connection with oral or dental surgery.
- Analgesia (e.g., nitrous oxide – oxygen sedation).
- Emergency care at a dental facility outside of the service area is limited to $50.
- Emergency palliative treatment (relief of pain).
- Emergency denture repairs and adjustments. The participant also pays the laboratory charges.
- Filling restorations of diseased or broken teeth. Materials used to restore teeth will be amalgam, composite or plastic.
*Posterior composite restorations: if a satisfactory result can be obtained with an amalgam restoration, but the member and Doctor select composite, the benefit is limited to the amount of the amalgam restoration, the member pays the difference.
- Limited bleaching of teeth as a result of discoloration due to injury or disease.
- Specific Inlays, Onlays, and Crowns to restore diseased or broken teeth when the tooth cannot be restored by methods described above. The participant also pays the laboratory charges.
Crowns and Bridges
- Porcelain, premium porcelain, porcelain with gold, premium porcelain with gold, non- and semi-precious porcelain and full cast gold have a fixed benefit amount. Contact Patient Accounts prior to your appointments to obtain fee estimates for these services.
- Oral surgery not already covered by your group health policy.
- Oral surgery for extraction of erupted and impacted wisdom teeth is covered by the participant’s group health plan. Refer to plan summaries for affiliated provider listings and deductibles.
- Root Canal Anterior, Bicuspid, Molar, Endodontic Retreatment, Apicoectomy – Anterior, Bicuspid, Molar, Pulp Capping.
*Certain endodontic procedures are not a covered benefit under the plan. Please check with Patient Accounts prior to your appointment regarding fees due.
- Treatment, not already covered by your group health policy, of periodontal diseases of the gums and supportive tissues of the teeth.
Certain surgical and non-surgical periodontal services (i.e. bone and tissue graft procedures, crown lengthening Perio Splints, Distal Wedge Procedures) are not covered benefits under the plan. Please check with Patient Accounts prior to your appointment regarding fees due.
(removable complete and partial dentures and bridges).
Most Prosthodontic procedures including repairs and relines have a lab fee due in addition to the member co-pay.
- Initial insertion of partial or complete removable dentures (including any adjustments).
- Replacement or modification (i.e., addition of teeth) of existing fixed bridges or dentures (full or partial). Replacement of prosthodontic appliances shall be covered hereunder only if at least five (5) years have elapsed since the date of the initial insertion of that appliance.
*Denture rebase procedures for complete and partial dentures is not a covered benefit under the plan.
*Certain precision attachments are not covered under the plan. Fixed partial Denture Retainers-Inlays/Onlays are not covered under the plan.
*Certain Fixed Partial Denture Retainers have a fixed benefit amount or a laboratory fee due. Check with Patient Accounts prior to your appointment regarding fees due for these services.
Orthodontics (subject to deductible)
- Orthodontic diagnostic procedures and treatment including surgical and appliance therapy.
- Each participant is entitled to one complete course or orthodontic treatment while you have coverage under this Plan. The patient pays half (50%) the cost, up to a maximum deductible of $2,000 per participant. If, at the participant’s request, the orthodontic treatment is ended before completion, benefit payments will end with the day of termination of treatments. If dental services are resumed a new deductible must be met. If, at the orthodontist’s suggestion due to growth issues, the treatment is ended and later resumed, the remaining orthodontic benefits will resume. There is no age limit on orthodontic services.
Patients are responsible for ALL laboratory charges. Laboratory charges are defined to be those actual costs for making or repairing any prosthetic device (such as bridges, dentures or crowns). All laboratory fees must be paid in full by the time the appliance is received. Patients should check with the Patient Accounts staff at the Dental Clinic of Marshfield, S.C. regarding lab fees due. Patients can also request an estimate prior to any work done requiring laboratory charges.
A participant must have denture made. All primary fittings and adjustments are done by the dentist in the office. The final processing of the denture is done by a dental laboratory. The participant pays for the laboratory charges (material and labor) for constructing the denture plus the amount not covered by the plan. Payment is due in full by the time the denture is inserted. Down-payments can be made prior to the insert appointment.