Dental Plans
The Dental Plans available under the City of Mesa are self-insured and self-administered.
Claims are sent to and processed by the City of Mesa Employee Benefits Office.
Members may choose among three different dental plans depending upon their
individual needs.
On any of the three plans, you may choose any licensed dental care provider.
The three dental plans offered are:
- Preventative Choice Plan - Provides
100% coverage for preventative services and pays
80% up to $500* on limited restorative care
(basic restorative care only). Orthodontia is
not covered.
- Dental Choice Plan - Provides 100%
coverage for preventative services, and pay 80%
up to $1200* on basic and major restorative
coverage. Orthodontia is not covered.
- Dental Choice Plus Plan - Provides
100% coverage for preventative services, and pay
80% up to $1500* on basic and major restorative
coverage. Orthodontia for dependent children
under age 19 only is covered at 80% up to $1200
per calendar year ($2400 lifetime max).
All plans are paid at reasonable and customary
(R&C) charges. See below for more information.
*Subject to $100 deductible per person/$300
family maximum.
| SERVICES |
PREVENTATIVE
CHOICE |
DENTAL
CHOICE |
DENTAL CHOICE PLUS |
Preventative visits (not subject
to deductible) Includes exam, tooth cleaning, bitewing x-rays
(Excludes periodontal cleanings & services)
Full mouth/panoramic x-rays limited to once every 36 months.
|
100% |
100% |
100% |
|
Basic Restorative (sealants*, fluoride, fillings, extractions)
*Coverage
limited to dependent children under age 19 only |
After deductible, 80% |
After deductible, 80% |
After deductible, 80% |
| Major Restorative (crowns, bridges, root
canals, dentures, oral surgery, periodontia, &
endodontia) |
Not Covered |
After deductible, 80% |
After deductible, 80% |
Orthodontia**
**Coverage
applies only to dependent children under age 19 |
Not Covered
|
Not Covered |
No Deductible, 80% Coverage,
$1200 Maximum Payable/Year
$2400 Maximum Payable Lifetime |
| Annual Maximum Payable for Dental
Services |
$500 per
person |
$1200 per person |
$1500 per person |
Non-Covered
Services
As with the medical plan, there are certain services that are not
covered under any of the dental plans. They include:
-
Expenses
exceeding the Usual, Reasonable, and Customary
amount;
-
Orthodontia
that started before benefits began with the City
of Mesa;
-
Analgesia,
sedation, hypnosis, nitrous oxide and/or related
services provided for apprehension or anxiety,
except when approved by the Plan Administrator;
-
Cosmetic
services, including but not limited to veneers
and facings;
-
Drugs and medicines;
-
Duplication of
dental services by another provider;
-
Home use
supplies, such as dental rinses, toothpaste,
fluoride, etc.
-
Dental
Implants;
-
Athletic mouth
guards;
-
Oral hygiene
or dietary instructions;
-
Periodontal
splinting;
-
Sealants for
adults.
For more detailed
information about services that are not covered,
please refer to the
Plan
Document or contact Employee Benefits at (480)644-2299.
Reasonable and Customary Charges
All dental charges submitted to the Benefits Office for consideration
are subject to reduction based upon the reasonable and customary
schedule for the geographic location in which the services were
rendered. Any amounts over the reasonable and customary (R&C) amount
are to be paid by the patient.
Dental Premiums
Dental premiums can be found on our Premiums
page, along with the medical, dental and vision premiums.
For a summary of detailed coverage, please refer to the following links:
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