While the information below provides an overview of the dental and vision coverage, more comprehensive information, including cost, can be found in the PEBA Insurance Benefits Guide [pdf].
State Dental Plan
This is a basic plan that provides minimal coverage and includes four classes of services:
- Class I (Preventive/Diagnostic) pays 100% of the established fee schedule.
- Class II (Basic Services), with Class III, has a combined annual deductible of $25 for each covered person, then pays 80% of the fee schedule.
- Class III (Prosthetics), with Class II, has a combined annual deductible of $25 for each covered person, then pays 50% of the fee schedule.
- Class IV (Orthodontics) only covers dependent children under age 19, and covers 50% of the fee schedule up to a lifetime max of $1,000.
The maximum benefit per year for classes I, II and III is $1,000 per covered person. The deductible for family coverage is limited to three per family per year, $75. While this plan does provide some coverage, the coverage is minimal and, in most instances, will not provide total coverage of the claims.
The Dental Plus plan is a supplement to the State Dental Plan. To participate in Dental Plus, you must enroll in the State Dental Plan and cover the same family members under both plans. This plan provides a higher level of coverage for most of the services covered under the State Dental Plan and is NOT an offset program that pays what the State Dental Plan does not. Instead, it covers the same procedures and services (except orthodontia) at the same percentage levels as the State Dental Plan, but has a higher fee schedule. The combined maximum per year for Dental Plus coverage is $2,000 per covered individual.
- An annual comprehensive eye exam once a year
- Standard plastic lenses or contact lenses once a year
- Frames once every two years
Discounts on conventional contact lenses, additional eyeglasses and more are offered through the plan. Co-pays are required for some services and the plan provides coverage for out-of-network services. Review EyeMed summary of benefits [pdf] for more details.