Program Overview
	Medical/Prescription Drugs
	Dental
	Vision Care
	State Group Life Insurance
	Life and AD&D Insurance
	Long-Term Disability Insurance
	Flexible Spending Plan
	Employee Assistance Program
	Behavioral Health / Emotional Wellbeing
	Disability Insurance
	Administrative Information
	What Happens When...?

What Is Covered

The plans pay for many of the preventive, basic and major services you and your family receive. The following services are covered under each plan:

Preventive Services

• Routine oral exams every six months
• Teeth cleaning every six months (including scaling and polishing for covered members age 14 and over)
• Fluoride application for dependent children to age 18 once a year
• Bitewing X-rays every six months
• Full mouth series or panoramic X-rays once every three years

Basic Services

• X-ray and pathology
• Space maintainers
• Non-surgical extractions
• Oral surgery
• General anesthetics in connection with covered dental services
• Periodontics, endodontics, and root canals for impaired teeth only (excluding final restoration)
• Restorative dentistry including fillings, pins, stainless steel crowns, denture repairs, adding teeth to partial dentures (that replace natural teeth), recementation, and repairs to bridges and crowns
• Treatment of diseased periodontal structures
• Endodontic treatment. This includes root canal therapy.
• Injection of antibiotic drugs.
• Repair or recementing of crowns, inlays, bridgework or dentures.
• Relining of dentures
  

Major Services

• Replacement of an existing removable denture or fixed bridgework by a new denture, or the adding of teeth to a partial removable denture*
• Inlays, gold fillings or crowns. This includes precision attachments for dentures
  
• First installation of fixed bridgework to replace one or more natural teeth extracted while the person is covered. This includes inlays and crowns as abutments
• Replacement of an existing removable denture or fixed bridgework by new fixed bridgework, or the adding of teeth to existing bridgework*

* The following Prosthesis Replacement Rule must be met: (a) The replacement or addition of teeth is required to replace teeth extracted after denture or bridgework was installed (extraction must have been covered under Plan); (b) The denture or bridgework (must be 5 or more years old) cannot be made serviceable; (c) The denture must be an immediate temporary one to replace natural teeth extracted while you are covered and cannot be made permanent; and (d) Replacement by a permanent denture must be needed. Replacement must take place within 12 months from the date the immediate temporary one was first installed.

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