Appendix_1_-County_of_Orange_Dental_Plan.pdf

This document is the County of Orange Dental Plan document, a detailed benefits plan for employees of the County of Orange, California, effective January 1, 2024. The plan provides comprehensive dental coverage for eligible County employees and their dependents, offering a range of dental services including diagnostic, preventive, basic, and major services. The dental plan is administered by a third-party claims administrator and covers network and non-network dental services with specific deductibles, coinsurance rates, and annual maximum benefits.

The plan features a calendar year deductible of $50 for individuals and $150 for families, with a $2,000 annual maximum benefit per covered person. Covered services include diagnostic and preventive services at 100% coverage, basic services at 90% coinsurance, and major services at 50% coinsurance. Special provisions include enhanced dental benefits for pregnant women, orthodontic services for dependent children with a $1,500 lifetime maximum, and implant services with a separate $1,500 annual maximum. The plan also incorporates HIPAA privacy and security provisions, and outlines detailed claim procedures, appeal processes, and coordination of benefits with other insurance plans.