Dental Plan

The Carle Health Dental Plan covers most types of preventive care and early treatment at 100% of usual and customary charges with no deductible. Other types of dental care and treatment, such as fillings, crowns, bridges, dentures and root canal therapy are paid at a percentage, detailed here. Administered by Health Alliance, you can choose any dental provider.

Dental plan benefits are separate from your medical benefits and will need to be elected separately for coverage to be effective.


DEDUCTIBLE AND COVERAGE INFORMATION
  Standard Enhanced
Annual
deductible
Individual: $50
Family: $150
Any combination of family members may satisfy the family deductible
Individual: $50
Family: $150
Any combination of family members may satisfy the family deductible
Lifetime Deductible for Orthodontia Individual: $50 Individual: $50
Policy Year Benefit Maximum $1,500 $2,500
Lifetime Benefit Maximum for Orthodontia Services $1,500 $3,000
Preventive Care 0%
Limited to two per calendar year
0%
Limited to two per calendar year
Basic Care 20% after deductible 20% after deductible
Major Care 50% after deductible 50% after deductible
Orthodontia 50% after deductible
Limited to covered dependents under the age of 25
50% after deductible
Limited to covered dependents under the age of 25

2024 Team Member Dental Plan Premiums (Bi-Weekly, 24 pay periods)

Full-Time Rates | 30 – 40 hours per week
  Standard Enhanced
Team Member $8.84 $12.60
Team Member & Spouse/Domestic Partner $17.69 $25.21
Team Member + Child(ren) $16.86 $24.03
Family $25.71 $36.64
Part-Time Rates | 20 – 29.99 hours per week
  Standard Enhanced
Team Member $11.05 $14.81
Team Member & Spouse/Domestic Partner $22.11 $29.63
Team Member + Child(ren) $21.07 $28.24
Family $32.14 $43.07

SCENARIOS

Scenario 1 (oldest child with braces)
Alex is 45 years old, working full-time with two children covered on the Dental Plan. This year, Alex’s oldest needed braces.
 

  STANDARD ENHANCED
  Serivce Provided Cost Incurred Service Provided  Cost Incurred

Orthodontia Services
($5,000 Total Charges)
$50 deductible

$4,950 (50% coinsurance of remaining charges up to lifetime limit)
+$50
 
+$3,450
$50 deductible

$4,950 (50% coinsurance of remaining charges up to lifetime limit)
+$50

+$2,475
Annual Premiums $16.86 bi-weekly premium (x24 pay periods) +$404.64 $24.03 bi-weekly premium (x24 pay periods) +$576.72

Annual Exam and Cleaning

 ($0 covered under preventive care) $0  ($0 covered under preventive care) $0
Tax Savings Opportunity Fleixble Spending Acccount   Health Savings Account  
Cost Summary   $3,904.64   $3,101.72
 

Scenario 2 (Basic and major care needs for spouse)
Eric is 30 years old and works full-time covering a spouse on dental coverage. This year Eric’s spouse needed a filling and two crowns.
 

  STANDARD ENHANCED
  Service Provided Cost
Incurred
Service Provided Cost Incurred

Filling for one tooth
($250 total charges)
$50 deductible 

$40 (20% coinsurance on remaining charges)
+$90
 
$50 deductible 

$40 (20% of remaining charges)
+$90

Crown for one tooth
($2,000 total charges)
$1,000 (50% coinsurance) +$1,000 $1,000 (50% coinsurance)  +$1,000

Crown for one tooth
($1,200 Total Charges)
50% coinsurance up to the annual limit +$860
 
Annual limit met
50% coinsurance up to the annual limit  +$600
Annual Cleanings $0 (Covered at 100% under preventive care)  +$0 $0 (Covered at 100% under preventive care)  +$0
Annual Premiums $17.69 bi-weekly premium (x24 pay periods) +$424.56 $25.21 bi-weekly premium (x24 pay periods)  +$605.04
Tax Savings Opportunity Fleixble Spending Acccount   Health Savings Account  
Cost Summary   $2,374.56   $2,295.04

 Good to Know

• Preventive care: Diagnostic services such as exams, X-rays and cleanings (two per calendar year).
• Basic care: Restorative and periodontics services such as fillings or removal of diseased gum tissue.
• Major care: Supplemental and prosthetic services such as implants or bridges.
• Orthodontia: Orthodontic services (for unmarried dependent children under 25).
• Policy year benefit maximum: The limit for amount of claims paid per covered member per year.