With Incentive Dental, your employees are rewarded for taking care of their teeth! Starting at 70%, their benefit payments increase 10% each year up to 100% as long as they go to the dentist for a regular exam each consecutive year. At the same time, for each year that a member does not receive preventive care, the amount payable will decrease by 10%.
Payment for covered preventive and basic care services is never less than 70% of the maximum allowance and never more than the maximum allowance.
Incentive Dental uses the traditional network and has a $1,000, $1,250 or $1,500 maximum benefit per year. It includes coverage for preventive, basic and major care services.
Preventive Care Benefits
Services include preventive dental care including exams, x-rays, cleanings, palliative treatments, fluoride (for enrolled eligible dependent children up to age 19), and sealants for certain teeth (for enrolled eligible dependent children up to age 16). Benefits are available for one (1) oral exam every six (6) months per insured.
Basic Care Benefits
Benefits include basic services such as fillings and pin retentions, simple extractions, oral surgery, root canal therapy, and periodontal maintenance. Depending upon the plan chosen, there may be a six-month waiting period for basic services.
Major Care Benefits
Incentive Dental pays 50% of the maximum allowance for major care covered services, regardless of the “incentive level” the insured has attained. Services include prosthetic and restorative treatments, such as crowns and repair of crowns; bridgework and repair of bridgework; dentures and the repair, adjustment, and relining of dentures; inlays and onlays; and cast porcelain restorations. Depending upon the plan chosen, there may be a 12-month waiting period for major services.
Optional Orthodontic Benefits
Orthodontic benefits are available to groups that have 20 or more enrolled employees. Benefits for orthodontic services are available only to insured dependent children, with age maximums as stated in the employer’s plan. The orthodontic option pays 50% of the maximum allowance for covered services up to a lifetime benefit limit of $1,000, $1,250 or $1,500 per enrolled dependent child. Benefits are provided for installation of appliances to straighten teeth and to correct abnormally positioned teeth.
This outline is a brief description of the coverage issued to the group. This is not a contract. The policy describes in detail the rights and obligations of both the group and Blue Cross of Idaho under the group policy. It is important that you read the policy carefully. The benefits of the policy are governed primarily by Idaho law.