Contract_Appendix_VI_-_Dental_Plan_Document_2024_Signed.pdf

This document is a Dental Plan Document for the County of Orange, California, effective January 1, 2024. The plan provides dental benefits for eligible County of Orange employees and their dependents, covering a range of dental services including diagnostic, preventive, basic, and major services. The plan is administered by a third-party Claims Administrator and offers coverage through both network and non-network dentists.

The dental plan includes a Calendar Year Maximum Benefit of $2,000 per covered person, with a separate Implant Calendar Year Maximum Benefit of $1,500. The plan features a Calendar Year Deductible of $50 for individuals and $150 for families. Covered services are reimbursed at different coinsurance rates, with diagnostic and preventive services covered at 100%, and basic services like fillings and oral surgery covered at 90%. Major services such as implants, prosthetics, and orthodontics are covered at 50%. The plan also provides enhanced dental benefits for pregnant women and includes specific limitations and exclusions for various dental procedures.