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Regardless which medical plan you select, dental coverage
is included automatically to all employees and retirees with
medical coverage. Employees who waive their medical coverage
through the City of Sarasota can elect DENTAL ONLY. However,
at this time it is offered to the employee only. We cannot
offer dental only benefits to dependents. Currently
dependents must be on employee medical coverage to receive
dental coverage.
You
may choose any dentist you like, however we offer a PPO
Dental Network. The advantage of accessing a network
dentist is they charge a set fee schedule. Out-of-network
dentists charge their own fee schedules. WEBTPA pays
on "usual and customary charges" only.
Therefore, if
a procedure
exceeds the usual and customary charge, you are responsible
for the difference.
The
entire fee schedule is online at www.hcsrq.com.
Be sure the procedure you need is covered under your plan.
Please check through WEBTPA to be sure at 1-877-697-2299.
You may also request a "pre-estimate" from the dentist.
The dentist submits his charges to WEBTPA and you receive,
in writing, exactly what is covered and what you will be responsible
for.
There
is a $50 deductible per person per calendar year. You
do not have to meet your deductible for cleanings. You
are allowed two cleanings per calendar year. They will
be processed at 80%. However, if you go out of network
and the amount exceeds usual and customary, you are responsible
to pay the difference.
After
meeting your deductible, claims will be paid at 80% for basic
services (fillings, x-rays, root canals) and at 50% for special
services (bridges, crowns, etc.) Our plan has a limit of $1,500
per calendar year per person for eligible dental expenses
so please advise your dentist of this limit. Orthodontia is
provided in the amount of $1,500, details of which are in
the SPD (Summary Plan Description).
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