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Dental


Dental Plan

Learn more about the Dental Plan

The Dental Plan provides comprehensive dental coverage. The maximum amount that the plan will pay each year is $1,500 (not including orthodontia expenses) per covered person after a $50 deductible. There are no deductibles for preventive dental services or orthodontia. Orthodontia (for dependent children under the age of 19) has a separate lifetime maximum of $1,500 per covered person. In-network plan benefits are:

  • Preventive Services 100%*
  • X-Rays 100%*
  • Primary Services 80%*
  • Major Services 50%*
  • Orthodontics 50%*

*Out-of-network services are subject to local reasonable and customary charges.


Vendor Contact Information
BlueCross and BlueShield Dental 
Group #000155
P.O. Box 23059
Belleville, IL 62223-0059
(800) 367-640

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