September 6, 2010
Effective January 1, 2008, Part XIV of the Summary Plan Description describes the Dental Benefit for Employees and Dependents.
 

Effective January 1, 2008, Part XIV of the Summary Plan Description describes the Dental Benefit for Employees and Dependents. Some benefits are limited so that a certain number of visits or treatments will be covered in a specified period of time. The portion of section 14.3, describing Coverage A, is amended as follows to clarify that a benefit period is a calendar year:

14.3 Covered Services and Benefits
Coverage A
  • oral examinations, twice in any benefit periodcalendar year
  • diagnostic x-rays as required
  • full-mouth x-rays, once every five years (for example, if you have a full-mouth x-ray on 2/6/2005 you are not eligible for coverage of another full-mouth x-ray until 2/6/2010)
  • dental prophylaxis twice in any benefit periodcalendar year (cleaning, scaling and polishing including periodontal maintenance visits)
  • topical fluoride application for patients under age 19, once in any benefit periodcalendar year
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