Dental plans for happy employees 2018 Dental Plans for Montana Small Groups
You and your employees are a community. Your employees are more than valuable assets to your business they re part of your organization s community. We know you want what s best for them. Let s take care of them, together. 2
Dental Plans Give your employees more to smile about. Good dental health and regular preventive care are important to your employees overall well-being. That s why we offer dental plans that you can buy stand-alone or group with a medical plan. If a dental plan doesn t fit into your budget, but you still want to offer your employees great coverage, our Voluntary Dental options may be just right for you. 3
Dental Plans About Our Dental Plans Note Group Size Requirements The listed group size requirement applies when the dental plan is purchased as a stand-alone plan. When grouped with a medical plan, all dental plans are available. Give your employees a voluntary dental option. If you re not looking to offer a dental plan, but want to make sure your employees have a dental option, then Voluntary Dental may be just what you need. With this option, your employees pay the full premium as if they were buying their own dental plan, but they get plan benefits that typically come with a dental plan that you might offer as an employer. The bottom row of each plan table will tell you if that plan is available as a voluntary dental plan. Please note that there are additional guidelines and requirements for voluntary dental plans. Download our voluntary dental brochure at PacificSource.com/montana/voluntarydental.pdf. 4
Dental Choice Dental Choice Core Group size requirements Groups with one or more employees Dental Plans Plan availability Annual maximum benefit The most we will pay in a calendar year for adults 19 and older. Annual deductible The amount your employees have to pay in a calendar year before their plan pays for Class II and Class III services. See page 7. Pediatric out-of-pocket limit The most your employees will pay in a calendar year for members through age 18. Co-insurance Your employees share of costs after they ve paid any deductible that apply. See page 7 for more about Class I, II, and III services. Adult waiting period There is no waiting period for members through age 18. Available as a voluntary dental plan? Available only from PacificSource Class I: Unlimited Class II: $500 Class III: not covered Individual: $50 Family: $150 One child: $350 Two or more children: $700 Through age 18: Class II: 6 months Yes Age 19 and older: Class III: 100% Dental Choice 0/20/50 Group size requirements Plan availability Annual maximum benefit The most we will pay in a calendar year for adults 19 and older. Annual deductible The amount your employees have to pay in a calendar year before their plan pays for Class II and Class III services. See page 7. Pediatric out-of-pocket limit The most your employees will pay in a calendar year for members through age 18. Co-insurance Your employees share of costs after they ve paid any deductibles that apply. See page 7 for more about Class I, II, and III services. Adult waiting period There is no waiting period for members through age 18. Available as a voluntary dental plan? Groups with one or more employees Available from PacificSource and the Health Insurance Marketplace $750 (direct or through marketplace) $1,000 (direct only) $1,500 (direct only) Individual: $50 Family: $150 One child: $350 Two or more children: $700 Class II: 6 months (applies only to $750 annual max plan) Class III: 12 months Yes 5
Dental Choice Dental Choice Plus 0/20/50 Group size requirements Groups with ten or more employees Dental Plans Plan availability Available only from PacificSource Annual maximum benefit The most we will pay in a calendar year for adults 19 and older. Annual deductible The amount your employees have to pay in a calendar year before their plan pays for Class II and Class III services. See page 7. Pediatric out-of-pocket limit The most your employees will pay in a calendar year for members through age 18. Co-insurance Your employees share of costs after they ve paid any deductibles that apply. See page 7 for more about Class I, II, and III services. Adult waiting period There is no waiting period for members through age 18. Available as a voluntary dental plan? $1,000 or $1,500 Individual: $25 or $50 Family: $75 or $150 One child: $350 Two or more children: $700 None No Kids Dental Choice 0/20/50 or 20/40/50 (for members through age 18) Group size requirements Plan availability Annual maximum benefit The most we will pay in a calendar year for adults 19 and older. Annual deductible The amount your employees have to pay in a calendar year before their plan pays for Class II and Class III services. See page 7. Pediatric out-of-pocket limit The most your employees will pay in a calendar year for members through age 18. Co-insurance Your employees share of costs after they ve paid any deductibles that apply. See page 7 for more about Class I, II, and III services. Adult waiting period There is no waiting period for members through age 18. Available as a voluntary dental plan? Groups with one or more employees Available only from PacificSource N/A Individual: $50 Family: $150 One child: $350 Two or more children: $700 N/A No or Class I: 20% Class II: 40% 6
What s covered by our dental plans? Here is a brief list of services and treatments most commonly asked about. To get all the details, go to PacificSource.com/montana/small-group-plan-details-2018. Class I: Preventive Services Exams and x-rays Dental cleanings (prophylaxis or periodontal maintenance) Fluoride applications Sealant on bicuspids and permanent molars (kids through age 18 only) Brush biopsies Class II: Basic Services Simple extractions Periodontal scaling and root planning and/or curettage Full mouth debridement Fillings Dental Plans Class III: Major Services Complicated and oral surgery Endodontic (pupal therapy and root canal therapy) Periodontal surgery when preauthorized Full, immediate, or overdentures Crowns and bridges Child orthodontia (medically necessary only; all plans; kids through age 18) Cosmetic Orthodontia Available based on group size with any dental plan purchased direct through PacificSource (except Core and Kids plans) 16 50 enrolled employees: $1,000 lifetime max, 12-month wait period for adults age 19 and older; wait period reduced or eliminated with prior orthodontia coverage What s not covered? Here s a brief list of dental plan exclusions: Athletic activities Bone replacement grafts Cosmetic or reconstructive services and supplies (except as specifically provided for in the policy) Experimental or investigational procedures Fractures of the mandible Orthodontic services (except as specifically provided for in the policy) Services covered by your medical plan Temporomandibular joint (TMJ) You ll receive a full list of exclusions and limitations in your dental policy. Only the language in your policy is legally binding. 7
Dental Plans Contact your broker or our team for a quote. We re happy to help, Monday through Friday, from 8:00 a.m. to 5:00 p.m. Helena: (406) 422-1008 (855) 422-1008 Email: montanasales@pacificsource.com Web: PacificSource.com/montana/small-group-plan-details-2018. SMG11 0917 8