Dental Side-by-Side Benefit Comparison
**Coverage available only in New Jersey.
|
|
Cinnaminson Township Board of Education |
|
|
|
DOP |
HDC** |
TotalCare** |
|
Annual Deductible
|
Single
Family |
$0
$0 |
None
None |
None
None |
|
Annual Maximum |
|
$1,000 |
None |
None |
|
Orthodontia Max |
|
$1,000 |
None |
None |
|
Visits & Exams
|
Visit for Oral Examinations
Prophylaxis incl. scaling & polishing
Fluoride
|
100%*
100%*
100%*
|
100%
100%
100%
|
100%
100%
100%
|
|
X-rays
|
Periapical X-rays
Bite-wing x-rays
Full mouth series |
100%*
100%*
100%*
|
100%
100%
100%
|
100%
100%
100%
|
|
Endodontics
|
Pulp Capping
Root Canal therapy w/ x-rays & cultures
Pulpectomy
Apioectomy
Molar and/or complex root canal therapy |
75%*
75%*
75%*
75%*
75%*
|
100%
100%
100%
100%
60%
|
100%
100%
100%
100%
100%
|
|
Restorations
|
Amalgam (silver fillings)
Composite Fillings
Stainless steel crowns |
75%*
75%*
75%*
|
100%
100%
100%
|
100%
100%
100%
|
|
Periodontics
|
Scaling and root planning
Gingivectomy
Correction of occlusion
Subgingival curettage
Osseous surgery
|
75%*
75%*
75%*
75%*
75%*
|
100%
100%
100%
100%
60%
|
100%
100%
100%
100%
100%
|
|
Oral Surgery & Extraction
|
Uncomplicated extractions
Incisions and drainage of abscess
Surgical removal of erupted teeth
Removal of soft tissue impaction
Full or partial bony impation
|
75%*
75%*
75%*
75%*
75%*
|
100%
100%
100%
100%
60%
|
100%
100%
100%
100%
100%
|
|
Prosthodontics & Repairs
|
Inlays/Onlays
Crowns (Freestanding)
Full and partial dentures
Denture repairs
Crowns (abutments to bridgework)
Pontics (false teeth)
Space Maintainers
|
75%*
75%*
60%*
75%*
60%*
60%*
100%*
|
60%
60%
60%
60%
60%
60%
60%
|
100%
100%
100%
100%
100%
100%
100%
|
|
Orthodontia
|
Orthodontic fee for normal 24 month Banded case |
50%* |
60% |
100%** |
| Exclusions & Limitations |
|
DOP |
HDC |
TotalCare |
|
*Annual Maximum apply. **TotalCare ortho covered for children only to age 19. These services are also subject to Maximum Allowable Charge (MAC) limitations. HDC and TotalCare Dental benefits are available only when services are provided or coordinated by a Horizon TotalCare Dentist or an HDC Dentist. Procedures that require treatment by a specialist must be pre-authorized by Horizon Healthcare Dental Services. Coinsurance rates under the Horizon Dental Option Plan are based upon a percentage of Usual, Customary and Reasonable charges. If you are a dependent or have dental work in progress, you must wait until the work is completed before you enroll in HDC. The above information is provided for illustrative purposes only. Specific benefit levels and dental services are described more completely in the employee benefit books. The extent of insurance for each individual is governed at all times by the complete terms of the master group insurance contract issued by Horizon Blue Cross Blue Shield of New Jersey, Horizon Healthcare Dental Services and Horizon Healthcare Dental.
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For more information about your Horizon Healthcare Dental Benefits:
www.horizon-bcbsnj.com
Please remember your insurance benefits are limited to the terms, conditions, exclusions and limitations of the insurance carrier's policy. Nothing contained on this website shall be deemed to have altered, waived, or extended the coverage provided by the policy. This overview contains a general description of your medical program for your use as a convenient reference. Complete details of your program appear in the policy, which govern the benefits and operation of your program. The policy supersedes if there should be any inconsistency or difference between its provisions and the information in this overview. |
