 | MATRIX offers a flexible dental plan through Blue Cross Blue Shield. You and your covered dependents are free to choose your own dentist. If you go to a Network Provider (available in Georgia only, to see if your dentist is in the network call BCBS at 800-441-2273), the benefits described below will be paid based on a reduced fee schedule (this will mean less out of pocket). The network provider cannot balance bill for charges in excess of the fee schedule, and you get more services with your yearly maximum.
If you go to a non-contracted dentist, the benefits will be based on usual, customary, and reasonable (UCR) for that given area for any dentist you choose. Eligible dependent children are covered to age 20 or to age 26, if a full-time student.
You may enroll by submitting the Insurance Enrollment Form within 30 days of your hire date.
Preventive Services
The plan pays 100% of covered expenses including: oral examinations, x-rays, teeth cleaning, fluoride treatments, space maintainers, and topical sealant.
Basic Services
The plan pays 80% of covered expenses including: laboratory tests, fillings, root canals, endodontics, minor restorative procedures, and extractions.
Major Services
The plan pays 50% of covered expenses including: major restorative procedures, gold and porcelain fillings, periodontics and prostodontics.
Maximum Benefit
$1,500 per covered person per benefit year. A "benefit year" is the consecutive 12-month period which starts on January 1 and ends December 31 each year.
Orthodontia Benefits
The plan includes orthodontia benefits for covered dependent children up to age 19. Orthodontia benefits are paid at 50% of eligible charges with a lifetime maximum of $2,000.
Deductibles
A $50 calendar year deductible will be applied to each insured for basic and major services. No deductible for preventative or orthodontia services.
Pre-Treatment Review
When the expected cost of a proposed course of treatment is $200 or more, the dentist must send the Blue Cross Blue Shield a treatment plan before he/she starts. They review the plan and send an estimate of plan payments to the dentist. Failure to follow this procedure may result in lower reimbursement.
Late Entrant Waiting Period
If you do not take dental benefits for you and your eligible dependents when first eligible, you and your dependents will be considered late entrants at the time you do apply.
Late Entrant waiting periods will apply as follows:
| Preventative Services | No waiting period |
| Basic, Major, and Orthodontia Services | 12 months from date insured for dental |
The preceding information has been a brief illustration of coverage only. The employee benefit booklet contains a complete plan description. If there is a discrepancy between the illustration and the benefit booklet, the benefit booklet prevails.
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