DENTAL CARE
Insurer: Pacific Blue Cross
Policy Number: 20037
Annual deductible
N/A
Dental fee guide
PBC Schedule 3
Specialist fee guide
Fee Guide +10%
Termination Age
The last day of the month in the month in which the employee terminates, retires, or is no longer eligible for coverage.
Survivor extension
For Dental work already in progress, within 90 days following the employees death an eligible dependent of the deceased employee may have dental work completed that commenced as part of a series of planned dental treatment(s) while the employee was living.
Basic Services
Reimbursement
100%
Maximum
$1,500 maximum per calendar year combined with Endodontics/Periodontics and Major Restorative Services
Adult check-up
2 per Calendar year
Child check-up
Once every 6 months
Endodontic/Periodontic Services
Reimbursement
100%
Maximum
$1,500 maximum per calendar year combined with Basic and Major Restorative Services
Major Restorative Services
Reimbursement
60%
Maximum
$1,500 maximum per calendar year combined with Basic and Major Restorative Services
Orthodontic Services
Reimbursement
75%
Maximum
$5,000/Lifetime
Age limit
Covers adults and children
GROUP LIFE
Insurer: Pacific Blue Cross
Policy Number: 79520
Schedule
Flat $25,000
Maximum
$25,000
Termination age
The last day of the month in the month in which the employee terminates, retires, or is no longer eligible for coverage.
Age reduction
N/A
Waiver of premium definition
Matches LTD
Optional life
Available