Sonic BlueSelect Voluntary Group Dental Benefits Summery

100%

Diagnostic and preventive services are paid at 100% with no waiting period, if services are received from a participating LINCS Dental Connection Network dentist. When covered treatment is performed by a non-participating dentist, the procedures are covered at 80 percent of allowable charges. No front-end deductible is required for diagnostic and preventive services.

80%

Primary restorative procedures (maintenance services, oral surgical services and periodontic services) are paid at 80 percent, after a *$50 deductible, if received from a participating in-network dentist. Coverage begins after a six-month waiting period. When covered treatment is performed by a non-participating dentist, the procedures are covered at 60 percent of allowable charges, after the *$50 deductible.

50%

Complex restorative procedures (complex restorative procedures, dentures, partials and bridges, denture adjustments, relining or rebasing and fixed bridge repairs) are paid at 50 percent, after a *$200 deductible, if received from a participating dentist. Coverage begins after a 12-month waiting period. When covered treatment is performed by a non-participating dentist, the procedures are covered at 30 percent of allowable charges, after the *$200 deductible.

This plan has an annual benefit maximum of $1,000.

*Per person, per benefit period.

This benefit summary does not contain a complete list of benefits, nor does it contain the list of exclusions and limitations.

Click here for 2009 Enrollment Forms