Dental - Compare Options
                        
                    
                
            
        
    
            
            
    Dental - Compare Options
            This Dental Plan Comparison Chart includes the coverage levels for commonly used services. This comparison chart does not reflect all dental plan services, exclusions, limitations, or restrictions. It is not considered a contract or guarantee of coverage under the Plans. Refer to the 
	Summary Plan Document 
	located at 
	www.oraclebenefits.com
for more details on Plan provisions and limitations.    
        
        
    
Dental Plan 1 (No Cost)                                
                                     
                                    
Dental Plan 2                                
                                     
                                    
                                    Network:
$50 per individual/ $150 family
Non-Network:
$50 per individual/ $150 family
                                $50 per individual/ $150 family
Non-Network:
$50 per individual/ $150 family
                                    Network:
$50 per individual/ $150 family
Non-Network:
$50 per individual/ $150 family
                        $50 per individual/ $150 family
Non-Network:
$50 per individual/ $150 family
                                    Network:
Not Covered
Non-Network:
Not Covered
                                Not Covered
Non-Network:
Not Covered
                                    Network:
$2,000
Non-Network:
$2,000
                        $2,000
Non-Network:
$2,000
                                    Network:
100% (No Deductible)
Non-Network:
100% (No Deductible)
                                100% (No Deductible)
Non-Network:
100% (No Deductible)
                                    Network:
100% (No Deductible)
Non-Network:
100% (No Deductible)
                        100% (No Deductible)
Non-Network:
100% (No Deductible)
                                    Network:
80% (After Deductible)
Non-Network:
80% (After Deductible)
                                80% (After Deductible)
Non-Network:
80% (After Deductible)
                                    Network:
80% (After Deductible)
Non-Network:
80% (After Deductible)
                        80% (After Deductible)
Non-Network:
80% (After Deductible)
                                    Network:
50% (After Deductible)
Non-Network:
50% (After Deductible)
                                50% (After Deductible)
Non-Network:
50% (After Deductible)
                                    Network:
80% (After Deductible)
Non-Network:
80% (After Deductible)
                        80% (After Deductible)
Non-Network:
80% (After Deductible)
                                    Network:
Not Covered
Non-Network:
Not Covered
                                Not Covered
Non-Network:
Not Covered
                                    Network:
50% (No Deductible)
Non-Network:
50% (No Deductible)
                        50% (No Deductible)
Non-Network:
50% (No Deductible)
                                
                                Preventive Dental Services
                            
                        
                                
                                Basic Dental Services
                            
                        
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                                80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                        80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                                80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                        80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                                80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                        80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                                80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                        80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                                80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                        80% after deductible
Non-Network:
80% (of UCR) after deductible
                                
                                Major Dental Services
                            
                        
                                    Network:
50% after deductible
Non-Network:
50% (of UCR) after deductible
                                50% after deductible
Non-Network:
50% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                        80% after deductible
Non-Network:
80% (of UCR) after deductible
                                    Network:
50% after deductible
Non-Network:
50% (of UCR) after deductible
                                50% after deductible
Non-Network:
50% (of UCR) after deductible
                                    Network:
80% after deductible
Non-Network:
80% (of UCR) after deductible
                        80% after deductible
Non-Network:
80% (of UCR) after deductible
                                
                                Orthodontia Services
                            
                        
                                    Network:
Not Covered
Non-Network:
Not Covered
                                Not Covered
Non-Network:
Not Covered
                                    Network:
50%
Non-Network:
50% (of UCR)
                        50%
Non-Network:
50% (of UCR)
                                    Network:
Not Covered
Non-Network:
Not Covered
                                Not Covered
Non-Network:
Not Covered
                                    Network:
50%
Non-Network:
50% (of UCR)
                        50%
Non-Network:
50% (of UCR)
This Dental Plan Comparison includes the coverage levels for commonly used services. This comparison chart does not reflect all dental plan services, exclusions, limitations, or restrictions. It is not considered a contract or guarantee of coverage under Plans. Refer to the Summary Plan Document located at www.oraclebenefits.com for more details on Plan provisions and limitations.
1 Fluoride and sealant treatments are limited to children to the age of 19 years old. Effective 01/01/2023: Sealants will be limited to one every 36 months upto age of 19, Fluoride will be limited to two every calendar year upto age of 19.
2 General Anesthetics is covered when given in connection with oral surgery or other covered dental services when medically necessary.
3 Limited to once every 5 years.
4 Lost, missing, stolen appliances - not covered. .
5 Composite filings and porcelain crowns will be covered 01/01/2023 with no alternate.