Dental Plan Options

Understanding Each Dental Plan Option

All three of the NCFlex Dental Plan options cover basic services including the cost of two cleanings and exams per calendar year and routine x-rays when you see an in-network provider. The Low Option requires a $25 deductible for the plan year on basic services. 

The benefits listed below are only a summary. View the certificate of coverage that corresponds to your plan for more information. Employees may register on MyBenefits to get information about what is and is not covered on the Dental Plan.

The High Option

Calendar-Year Maximum: $5,000 (Per covered person; excludes orthodontic services)

Lifetime Orthodontic Maximum: $1,500 (Per covered person. Lifetime max includes any reimbursement received from the prior carrier.)

Calendar-Year Deductible (per person/per family): $50/$150

Coverage

Tab/Accordion Items

Coverage: 100%

Includes:

  • Oral Examination (two per calendar year)
  • Cleaning (two per calendar year)
  • X-rays (one bitewing x-ray per calendar year; one full-mouth radiograph series or panoramic series every five years)
  • Topical Flouride (two per calendar year under age 19)
  • Sealants for Permanent First and Second Molars (under age 16; see certificate of coverage for frequencies)
  • Space Maintainers (under age 19)

Coverage: 80% after deductible

Includes:

  • Fillings (amalgam, synthetic or composite; replacements limited to once every 24 months)
  • Simple Extractions
  • Endodontics (root canal treatment)
  • Re-Cement Crowns, Inlays, Bridges
  • Repair of Removable Dentures
Coverage: 50% after deductible

Includes:

  • Periodontal Services (gingivectomy, gingivoplasty, osseous surgery, scaling and root planing)
  • Periodontal Maintenance After Therapy (two per consecutive 12 months)
  • Oral Surgery (wisdom teeth extractions)
  • General Anesthesia

Coverage: 50% after deductible

Includes:

  • Crowns including Single Implant Crowns (Not eligible for dependent children under 14; replacements limited to every seven years. Single prosthetic procedures are considered completed on the date they are inserted, not the date of impression.)
  • Dentures (Replacements limited to every seven years.)
  • Bridges (Replacements limited to every seven years.)
  • Fixed Bridge Repairs
  • Denture Adjustments/Relining (within six months of initial denture placement)
  • Implants

Coverage: 50%

Includes:

  • Orthodontic Treatment in Progress

Treatment plans not started under the High or Classic Options will be prorated based on the date the benefit is eligible on the dental plans. Reimbursement will not be paid beyond the date the child turns the age of 19.

The Classic Option

Calendar-Year Maximum: $1,500 (Per covered person; excludes orthodontic services)

Lifetime Orthodontic Maximum: $1,500 (Per covered person. Lifetime max includes any reimbursement received from the prior carrier.)

Calendar-Year Deductible (per person/per family): $25/$75

Coverage

Tab/Accordion Items

Coverage: 100%

Includes:

  • Oral Examination (two per calendar year)
  • Cleaning (two per calendar year)
  • X-rays (one bitewing x-ray per calendar year; one full-mouth radiograph series or panoramic series every five years)
  • Topical Flouride (two per calendar year under age 19)
  • Sealants for Permanent First and Second Molars (under age 16; see certificate of coverage for frequencies)
  • Space Maintainers (under age 19)

Coverage: 60% after deductible

Includes:

  • Fillings (amalgam, synthetic or composite; replacements limited to once every 24 months)
  • Simple Extractions
  • Endodontics (root canal treatment)
  • Re-Cement Crowns, Inlays, Bridges
  • Repair of Removable Dentures
Coverage: 50% after deductible

Includes:

  • Periodontal Services (gingivectomy, gingivoplasty, osseous surgery, scaling and root planing)
  • Periodontal Maintenance After Therapy (two per consecutive 12 months)
  • Oral Surgery (wisdom teeth extractions)
  • General Anesthesia

Coverage: 50% after deductible

Includes:

  • Crowns including Single Implant Crowns (Not eligible for dependent children under 14; replacements limited to every seven years. Single prosthetic procedures are considered completed on the date they are inserted, not the date of impression.)
  • Dentures (Replacements limited to every seven years.)
  • Bridges (Replacements limited to every seven years.)
  • Fixed Bridge Repairs
  • Denture Adjustments/Relining (within six months of initial denture placement)
  • Implants

Coverage: 50%

Includes:

  • Orthodontic Treatment in Progress

Treatment plans not started under the High or Classic Options will be prorated based on the date the benefit is eligible on the dental plans. Reimbursement will not be paid beyond the date the child turns the age of 19.

The Low Option

Calendar-Year Maximum: $1,000 (Per covered person)

Lifetime Orthodontic Maximum: N/A

Calendar-Year Deductible (per person/per family): $25/$75

Coverage

Tab/Accordion Items

Coverage: 100% after deductible

Includes:

  • Oral Examination (two per calendar year)
  • Cleaning (two per calendar year)
  • X-rays (one bitewing x-ray per calendar year; one full-mouth radiograph series or panoramic series every five years)
  • Topical Flouride (two per calendar year under age 19)
  • Sealants for Permanent First and Second Molars (under age 16; see certificate of coverage for frequencies)
  • Space Maintainers (under age 19)

Coverage: 50% after deductible

Includes:

  • Fillings (amalgam, synthetic or composite; replacements limited to once every 24 months)
  • Simple Extractions
  • Endodontics (root canal treatment)
  • Re-Cement Crowns, Inlays, Bridges
  • Repair of Removable Dentures
  • Periodontal Services (gingivectomy, gingivoplasty, osseous surgery, scaling and root planing)
  • Periodontal Maintenance After Therapy (two per consecutive 12 months)
  • Oral Surgery (wisdom teeth extractions)
  • General Anesthesia

Not covered under the Low Option.

Not covered under the Low Option.

Maximum Allowable Charge

Benefits are subject to the Maximum Allowable Charge (MAC). The MAC for in-network dental providers is the negotiated in-network fee. Reimbursement for out-of-network services is based on reasonable and customary (R&C) charge or the area. 

R&C is based on the lowest of (1) the dentist's actual charge, (2) the dentist's usual charge for the same or similar services or (3) the charge of most dentists in the same geographic area. The employee may be responsible for the difference between the R&C charge and what an out-of-network dentist charges.

Dental Plan Riders

In addition to the certificates of coverage, review plan riders for specific details on what is and is not covered on each option.