Heartspring Dental Plan

Heartspring Dental Services Covered

Heartspring offers Delta Dental Insurance. Employees have 30-days from the date of hire to make a decision about the dental plan. After this time frame, employees who choose to enroll in the dental plan will have to wait for the open enrollment period in February. The Delta plan provides employees with several different options. The most competitive rates are from Delta's "PPO List" which includes 90 doctors in the Wichita area. Employees may also use any one of the 250 dentists on Delta's "Premier List," but may be required to pay a higher percentage of the price for services. Employees may use any dentist in Kansas, however, Delta will only pay a percentage based on "Delta Dental's maximum plan allowance for non-participating providers."

Visit Delta Dental's website to find a participating dentist (*Select Delta Dental PPO).

The prices for our plan are:
Employee = $16.05
Employee + 1 = $31.06
Family = $54.52

Annual Maximum Benefit
The maximum payment for all covered dental procedures for each eligable person in any one calendar year is $1000.

Deductable Limitations
Coverage for diagnostic and preventative services is not subject to any deductable amount. For all other covered benefits, the calendar year deductable is $75 per person with a family maximum of $255.

Dependent Ages
Dependents are covered to age 19 or to age 24 if a full-time student.

Diagnostic & Preventative (Not subject to deductible)
PPO	Premier	Out of Network
100%	80%	80%	Diagnostic:	Includes the following procedures necessary to evaluate existing dental conditions and the dental care required: Oral examinations - once each six (6) months. Diagnostic x-rays - bitewings once each six (6) months for dependents under age 18 and once each 12 months for adults age 18 and over. Full mouth x-rays once each five (5) years.
100%	80%	80%	Preventive:	Provides for the following: Prophylaxis (Cleanings) - once each six (6) months. Topical Fluoride - once each six (6) months for dependent children under age 14. Space Maintainers - for dependent children under age 14 and only for premature loss of primary molars. Sealants - once (1) per lifetime for dependent children under age 15 when applied only to permanent molars with no caries (decay) or restorations on any surface and with the occlusal surface intact.
BASIC
50%	40%	40%	Ancillary:	Provides for one (1) emergency examination per calendar year by the Dentist for the relief of pain.
50%	40%	40%	Oral Surgery:	Provides for extractions and other oral surgery including required anesthesia and pre and post-operative care.
50%	40%	40%	Regular Restorative:	Provides amalgam (silver) restorations; composite (white) resin restorations on anterior (front) teeth*; and stainless steel crowns for dependents under age 12.
50%	40%	40%	Endodontics:	Includes procedures for root canal treatments and root canal fillings.
50%	40%	40%	Periodontics:	Includes procedures for the treatment of diseases of the tissues supporting the teeth.
MAJOR
50%	40%	40%	Special Restorative:	When teeth cannot be restored with a filling material listed in Regular REstorative Dentistry, provides for individual permanent crowns.
50%	40%	40%	Prosthodontics:	Includes bridges, partial and complete dentures, including repairs and adjustments.
ORTHODONTICS
Not Covered			Orthodontics:	Includes orthodontic appliances and treatment.

*The percentage is based upon Delta Dental's maximum plan allowance for non-participating providers.
*This is a summary of benefits only and does not bind Delta Dental of Kansas to any coverage. Coverage as described in the employer group's Agreement to Provide Dental Benefits (contract) is binding on all parties and supercedes all other written or oral communications.