The Health Trust offers a dental plan which covers Preventive/Diagnostic, Basic/Restorative, Major/Prosthodontic, and Orthodontic services. It is administered by Northeast Delta Dental.
Preventive / Diagnostic services include: oral exams (two per calendar year); cleanings (two per calendar year); bitewing x-rays (two sets per calendar year); full mouth x-rays (one set every 36 months); fluoride treatments (to age 19); space maintainers (to age 19); and sealants (to age 14). These services are covered at 100% of Reasonable & Customary charges. They are not subject to the deductible. These services do not accrue towards the annual maximum benefit.
Basic / Restorative services include: extractions; oral surgery; fillings; general anesthetics (when medically necessary); periodontal treatment; endodontal treatment; and antibiotics. These services are covered at 80% of Reasonable & Customary charges, after satisfaction of the $25 annual deductible.
Major / Prosthodontic services include: initial installation of bridgework; initial installation of partial or full removable dentures; inlays, onlays, and crowns; gold fillings; and repair or recementing of bridgework, dentures, crowns, or onlays. These services are covered at 50% of Reasonable & Customary charges, after satisfaction of the $25 annual deductible.
Coverage of Basic and Major services is subject to an annual maximum benefit of $1,250 per person. Coverage will be provided for all eligible Preventive and Diagnostic services, even after the annual maximum benefit has been met.
Orthodontic services are covered under the Health Trust Dental plan, to a lifetime maximum benefit of $1,250 per person. These services are covered at 50% of Reasonable & Customary charges, and are not subject to the deductible.
Please note: This is intended only as a summary of benefits. Please contact the Health Trust at 1-800-852-8300 for more information about any of the Health Trust plans.
Forms and Information:
- 2018 Dental Benefits Summary
- HOW Program Overview (effective 1/1/2018)
- Dental Enrollment/Change Form
- Dental Claim Form
- Instructions to find out if your dentist participates in the Delta Dental network
Delta Dental network: www.deltadental.com
Log in to check your Dental claims or request an ID card: www.nedelta.com