Horizon Dental Option Plan
The Horizon Dental Option Plan gives you the freedom to receive dental services from any dentist. When you use a dentist who participates with the Horizon Dental Option Plan, you maximize your benefits and save money. Additionally, when you use a dentist who participates in the Horizon Dental PPO Network, you receive deeper discounts and may save even more. You have the option of selecting from more than 200,000 office locations nationwide.
If you use an out-of-network dentist, you will still receive a benefit for eligible services. However, out-of-network dentists may charge up to their normal fees. Horizon Dental reimburses up to plan allowances. Charges above the plan allowance will be your responsibility. You may be required to pay at the time of service and submit a claim for reimbursement.
Deductible
The deductible is the amount you must pay each year for covered charges before benefits are paid by your plan. The deductible applies to Preventive & Diagnostic, Treatment & Therapy, Endodontics, Periodontics, Oral Surgery, Prosthodontics, Crowns and Onlays, and Orthodontics.
| Individual | $50 |
| Family | $150 |
Benefit Period Maximum
The benefit period maximum is the most the dental plan will pay toward the cost of dental care within the benefit year. The benefit period maximum applies to Preventive & Diagnostic, Treatment & Therapy, Endodontics, Periodontics, Oral Surgery, Prosthodontics, Crowns and Onlays, and Orthodontics
| Individual | $1,500 |
Orthodontics Eligibility- Child Only
| Orthodontics | 50% |
| Orthodontics Lifetime Maximum | $1,000 |
Coinsurance
Coinsurance is the fixed amount you must pay after you’ve paid the deductible for each medical visit to a participating doctor or other health care provider, usually at the time of service.
| Preventive Diagnostic | Strong Smile Rider | Excluded |
| Exam and Preventive Services Exams | 100% | |
| Fluoride Treatment | 100% | |
| Sealant Application | 100% | |
| Adult Prophylaxis | 100% | |
| X-rays (Bitewing & Full Mouth) | 100% | |
| Treatment and Therapy | Space Maintainers | 80% |
| Amalgam Restorations | 80% | |
| Composite Restorations – Anterior & Bicuspid | 80% | |
| Denture Adjustments | 80% | |
| Denture Repairs | 80% | |
| Simple Extractions | 80% | |
| Endodontics | Root Canal Therapy – Anterior & Bicuspid | 80% |
| Root Canal Therapy – Molar | 80% | |
| Periodontics | Scaling & Root Planing | 80% |
| Gingivectomy | 80% | |
| Periodontal Maintenance | 80% | |
| Osseous Surgery | 80% | |
| Oral Surgery | Surgical Extractions | 80% |
| Partial Bony Extractions | 80% | |
| Complete Bony Extractions | 80% | |
| Prosthodontics | Bridgework | 50% |
| Partial Dentures | 50% | |
| Crowns and Onlays | Crown – porcelain fused to high noble metal | 50% |
Eligibility
Dependent children of enrolled employees are covered to the age of 26.
Services are for illustrative purposes only. For complete listing of covered services, plan limitations, deductibles and maximums, consult your benefit booklet.
