Preventive dental benefits

G.E.H.A Standard, High and HDHP health plan members have access to the following preventive care dental benefits: 

Standard

In-network & out-of-network providers

Benefits are limited to (per person, per calendar year):

• 2 exams
• 2 prophylaxis (cleanings)
• 2 fluoride (no age limit)

Exams, prophylaxis and fluoride are paid at 50% of G.E.H.A's allowable amount. X-ray charges (no frequency/any type of X-ray) are paid at 50%, for a maximum of $75 paid per person per calendar year.

• One-surface filling, the plan pays $21 per tooth
• Two-or-more-surface fillings, the plan pays $28 per tooth
• Simple extractions, the plan pays $21 per tooth

No calendar year max. No deductible.

High

In-network & out-of-network providers

Benefits are limited to two visits per calendar year. The plan will pay $22 per visit, for a total of $44 paid per person per year. Visits may include any combination of:

• Exams
• Prophylaxis (cleanings)
• Fluoride (no age limit)
• X-rays (no frequency limit)

In addition:

• One-surface filling, the plan pays $21 per tooth
• Two-or-more-surface fillings, the plan pays $28 per tooth
• Simple extractions, the plan pays $21 per tooth

No calendar year max. No deductible.

HDHP

In-network & out-of-network providers

Benefits are limited to (per person, per calendar year):

• 2 exams
• 2 prophylaxis (cleanings)
• 2 fluoride (no age limit)

Exams, prophylaxis and fluoride are paid at 100% of G.E.H.A's allowable amount. X-ray charges (no frequency/any type of X-ray) are paid at 100%, for a maximum of $150 paid per person per calendar year.

In addition:

• One-surface filling, the plan pays $21 per tooth
• Two-or-more-surface fillings, the plan pays $28 per tooth
• Simple extractions, the plan pays $21 per tooth

No calendar year max. No deductible.