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Dental Benefits Summary: The Building Trades Plan

Benefit Coverage
Calendar Year Deductible
  • $75 per person; $225 per family
Calendar Year Maximum
  • In-Network: Plan pays up to $900 per person per calendar year toward all covered expenses.
  • Out-of-Network: Plan pays up to $750 per person per calendar toward all covered expenses.

Note: The calendar year maximum does not apply to pediatric oral care.

Preventive Care Services
  • Oral exams and routine cleanings: twice in a calendar year
  • Bitewing x-rays and fluoride applications for children under 19: once per calendar year
  • Sealants for dependent children: once every three consecutive calendar years
  • Full mouth x-rays: once every three consecutive calendar years
  • Brush biopsy to detect oral cancer
  • Emergency treatment to relieve pain
  • Cleanings following periodontal therapy
In- and Out-of-Network: Plan pays 100% of covered expenses, up to the reasonable and customary charge. There is no deductible.
Non-Preventive Services (below are some examples; for a complete list refer to the Summary Plan Description posted to the Forms & Documents page)
  • Space maintainers: once per lifetime
  • Extractions and oral surgery services
  • Fillings and crowns, repairs
  • Root canal therapy
  • Gold inlays
  • Bridges, implants and dentures: once per tooth in any five-year period
  • Periodontic services to treat gum disease
In- and Out-of-Network: Plan pays 75% of covered expenses, after the deductible, up to the reasonable and customary charge.