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Dental Insurance

Eligible employees can choose from two dental options:

Each year during the Annual Enrollment Transfer Period, eligible employees can enroll in or transfer between dental options.

(Note: Local Education Plan and Local Government Plan members should check with their agency benefits coordinator to see if dental insurance is available.)

View a comparison of the plans’ benefits »

Prepaid Plan

The Prepaid Plan provides dental services at predetermined co-pay amounts. Members must receive services from a participating network general dentist or specialist dentist. There is no deductible to meet, no claims to file, no waiting period and no annual dollar maximum. Pre-existing conditions are covered.

Assurant Employee Benefits administers the prepaid plan. You can search for participating dentists at Assurant Employee Benefits — select the DentiCare Network.

Preferred Dental Organization (PDO)

Under the PDO, members can choose any dentist; however, you receive maximum benefits when using a network provider. No referrals are required and you or your dentist file claims for covered services. Some services require waiting periods (e.g., orthodontia) and limitations and exclusions apply.

You pay co-insurance for many covered services and your share is based on the “maximum allowable charge” (MAC) for a given service. You will pay less out-of-pocket when seeking care from a network provider because network dentists and specialists typically agree to the allowable charge upfront. Out-of-network providers typically charge more than the allowable charge, resulting in higher costs for you.

Delta Dental administers the PDO. You can search for participating dentists at Delta Dental TN—select the Delta Dental PPOSM Network.

Plan Comparison

For more detailed information, member handbooks are available on the Benefits Administration website.

 

 

 Prepaid Plan PDO Plan

 

 General Dentist Specialist Dentist In-Network Out-of-Network

Plan Network

Assurant

Delta Dental

Annual Deductible

None

None

Employee Only: $100; Employee + Child(ren): $300; Employee + Spouse: $300; Employee + Spouse + Child(ren): $300

Annual Maximum Benefit

None

$1,500 per person, per year

Preexisting Conditions

Covered

Some exclusions apply

Office Visit

$10 co-pay

0% of MAC

20% of MAC

Periodic Oral Evaluation

No charge

0% of MAC

20% of MAC

Routine Cleaning (Adult)

No charge

0% of MAC

20% of MAC

X-ray—Interoral, Complete Series

No charge

$5 co-pay

20% of MAC

40% of MAC

Amalgam (silver) Filling—2 Surfaces Permanent

$8 co-pay

$10 co-pay

20% of MAC

40% of MAC

Endodontics—Root Canal Therapy Molar (excluding final restoration)

$250 co-pay

$600 co-pay

50% of MAC

Major Restorations—Crowns (porcelain fused to high noble metal)

$275 co-pay, plus additional lab fees

50% of MAC

Extraction of Erupted Tooth (minor oral surgery)

$15 co-pay

$70 co-pay

20% of MAC

40% of MAC

Removal of Impacted Tooth—Complete Bony (complex oral surgery)

$100 co-pay

$120 co-pay

50% of MAC

Dentures—Complete Upper

$310 co-pay, plus lab fees

50% of MAC

Orthodontics

25% off participating orthodontist’s usual fees

50% of MAC

Annual Deductible

None

None

Lifetime Maximum

None

$1,250 (additional limitations apply)

Waiting Period

None

12 months

Age Limit

None

Up to age 19

Note: This benefit comparison provides a summary of dental coverage only. This site does not outline every benefit, limitation or exclusion of the State-sponsored plans. The Plan Documents and Insurance Contracts governing the plans are the legal publications that define eligibility, enrollment, benefits and administrative rules. These documents are available from your agency benefits coordinator or through the Benefits Administration website. Should any questions arise about the nature and extent of your benefits, or if there is a discrepancy between the information presented through this website and the formal language found in the Plan Documents and Insurance Contracts, the Plan Documents and Insurance Contracts will govern.

The Insurance Committees or the Legislature may change the plans at their discretion, in which case you will be given written notice of the change.