Dental Plan

 

First Fortis Dental PPO

  For Services by a Preferred Provider Services by a Non-Preferred Provider

Annual Deductible

  • Individual Deductible Amount

  • Waived for Group I services

 

$50

Yes

 

$50

Yes

Annual Maximum

     Per Person Per Policy Year

$1,500

$1,500

Coinsurance Percentage

(of allowable charges)

Group I Dental Services

  • Oral Exams (1 in 12 mths)

  • Dental Prophylaxis (cleaning)

  • Fluoride Treatment

  • Sealants

100%

100%

Group II Dental Services

  • Simple Extractions

  • X-Rays

  • Fillings

80%

80%

Group III Dental Services

  • Endodontics

  • Periodontics

  • Complex Oral Surgery

  • Major Restorations

50%

50%

 

 

 

 

PPO Access Plan - This plan allows employees to see any dentist they want.  Fees are paid based on a usual and customary schedule.  By using a preferred Provider,  you get higher coverage amounts and lower fees.   Click here to search their network

 

 

 

Monthly Rates:

 

                    Single:                          $40.96

                    Emp + Spouse:            $80.67

                    Emp + Child(ren):       $84.36

                    Family:                        $124.07

 

Above is just a summary of benefits.  Benefits may change by the carrier as permitted by law.  Please email us or consult your benefit booklet for further information.