Dental benefits are provided for you and your covered eligible dependents if you are eligible
for, and have elected dependent coverage. If covered, a percentage of your covered dental
expenses will be paid, depending on the dental work, as shown in your Schedule of Benefits
(please see link below).
A maximum benefit per calendar year that is listed in your Schedule of Benefits will apply to
your total covered dental expenses under Coverages A, B and C, except that it does not apply to
coverage A expenses for enrollees under age 19. Orthodontia care for your eligible dependent
children is paid up to the maximum amount per lifetime per child that is listed in your Schedule
of Benefits. Dental benefits are counted toward your annual maximum dental benefit under the
Plan, and toward your medical benefit deductible and out-of-pocket maximum.
For more information regarding dental benefits please see pages 52-55 in your Summary