How the Dental Program works

The Dental Program has two options:

• The BP Dental Plan, which is administered by MetLife.
• If available in your area, the Dental Health Maintenance Organization (DHMO), which is a network-based plan administered by CIGNA Dental Health.

The options available to you will be reflected on your Personalized Enrollment Worksheet included in your annual enrollment packet each year.

Dental Program at-a-glance

This chart compares how treatments and services are covered under the two dental options:

	BP Dental Plan		Dental Health Maintenance Organization (DHMO)
	In-network	Out-of-network
General information
Plan-year deductible	$25/person   $75 family maximum	$50/person   $150 family maximum	None
Plan-year maximum benefit	$2,000/person for diagnostic and preventive services and for basic and major restoration services combined (in-network and out-of-network combined)	$1,500/person for diagnostic and preventive services and for basic and major restoration services combined (in-network and out-of-network combined)	None
Lifetime maximum benefit	$2,000/person for orthodontia (in-network and out-of-network combined)	$1,500/person for orthodontia (in-network and out-of-network combined)	None
For the following treatments and services, the dental options pay:
Covered services
Diagnostic and preventive services (e.g., routine oral exams, preventive cleanings, X-rays, fluoride treatments)	100% with no deductible   Note: Participants are eligible for three cleanings per plan year (in-network and out-of-network combined)	100% with no deductible   Note: Participants are eligible for three cleanings per plan year (in-network and out-of-network combined)	100% after scheduled preset charge**   Note: Participants are eligible for one cleaning every six months (two per plan year). Additional cleanings are available, but are subject to a copay
Basic restoration (e.g., fillings, extractions, oral surgery, treatment of gums, periodontal services, root canal therapy) (In the DHMO, some root canals fall into major restoration group.)	90% after deductible	85% after deductible*	100% after scheduled preset charge**
Major restoration (e.g., crowns and caps to repair teeth, dentures, bridgework, implants, prosthetics)	60% after deductible	50% after deductible*	100% after scheduled preset charge**
Orthodontia for adults and children (e.g., braces, retainers, oral exams, X-rays)	50% with no deductible, up to $2,000 per lifetime maximum shown above	50% with no deductible*, up to $1,500 per lifetime maximum shown above	100% after scheduled preset charge**

* Coinsurance benefit levels are subject to maximum allowable charge limits for services or supplies provided by an out-of-network provider.

** Provided in the patient charge schedule from CIGNA Dental Health.