2024-2025 Benefits Guide

DENTAL PLAN

The EAA offers two dental insurance plan options through Blue Cross Blue Shield (BCBS). Both plans are PPO plans that can meet your needs; the difference is how out-of-network benefits are reimbursed. If you visit a dentist in the BCBS network, you will receive the most savings through either plan. To verify that your dentist is in network, visit the BCBS BlueCare Dental Provider website, where can search by dentist name, location, county, or center name. If your dentist is in-network, the 100/60 Plan offers higher coinsurance amounts, providing increased coverage. However, if your current dentist is NOT part of the BCBS network and you prefer NOT to change dentists, the 80/50 Plan reimburses up to the 90th percentile of the Usual, Customary, and Reasonable (UCR) rates, usually leading to higher reimbursements and lower out-of-pocket costs for out-of-network services. For a brief overview of the two plans, please see the following comparison chart. This chart will allow you to compare the two plans side by side. IMPORTANT: After selecting a plan, you cannot change your selection until the next Open Enrollment period. DENTAL PLAN COMPARISON CHART BCBS BlueCare Dental 100/60 Plan 80/50 Plan Program Basics Contracting Dentist/ Non-Contracting Dentist Contracting Dentist/ Non-Contracting Dentist Benefit Period Maximum $1,500 $1,500 Deductible $50 Individual/$150 Family $50 Individual/$150 Family

Out-of-Network Reimbursement

MAC

90th UCR

Covered Services Diagnostic Evaluations Periodic oral evaluations

100% (Deductible does not apply)

100% (Deductible does not apply)

Problem focused oral evaluations Comprehensive oral evaluations Preventive Services Prophylaxis (cleanings) Topical fluoride applications Diagnostic Radiographs Full-mouth and panoramic films

100% (Deductible does not apply)

100% (Deductible does not apply)

100% (Deductible does not apply)

100% (Deductible does not apply)

Bitewing films Periapical films

Miscellaneous Preventive Services Sealants Space maintainers

100% (Deductible does not apply)

100% (Deductible does not apply)

Basic Restorative Services Amalgams Resin-based composite restorations

100%

80%

Non-Surgical Extractions Removal of retained coronal remnants Removal of erupted tooth or exposed root

100%

80%

Non-Surgical Periodontal Services Periodontal scaling and root planing

100%

80%

Full-mouth debridement Periodontal maintenance procedures

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