Major/Restorative

Coverage is per person per calendar year (January – December). For major restorative treatments over $800, a dental predetermination (treatment plan) is recommended.

• Enhanced Option 1: 100% of the Dental Benefit List fees for major/restorative treatments up to a maximum of $5,000  
• Enhanced Option 2: 50% of the Dental Benefit List fees for major/restorative treatments up to a maximum of $2,500 
• Core: 50% of the Dental Benefit List fees up to $2,000 for major treatments

Below is a list of some common major restorative procedures and coverage limitations:

• Bridges: Bridge replacements must be seven years old from the date of the last placement.
• Crowns: Crown replacements must be five years old from the date of last placement. Re-cementation of a crown is limited to twice per tooth per lifetime.
• Dental Implants: Surgical procedures, such as a dental implants, are limited to a maximum eligible amount of $3500 per tooth. Replacements must be 12 years old from the date of the last placement and plan maximums remain the same.
•  Dentures – Full and Partial: Denture replacements must be five years old from the date of the last placement.
• Inlays and Onlays: Inlay and onlay replacements must be five years old from the date of the last placement.
• Veneers: Veneer replacements must be five years old from the date of the last placement. Re-cementation of a veneer is limited to twice per tooth per lifetime. Veneers for cosmetic purposes are not covered.