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Emory Dental Plan


Corporate Information

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Accesss Plan T – 185 Dental Option

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Residents Only Dental Option

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  Traditional Benefit Schedule  
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Traditional Benefits Schedule

Dependent Age Limits
Eligible dependents include the spouse of an insured. Employee and all unmarried children from birth up to age 25.

Eligible children include legally adopted stepchildren and foster children, provided they are claimed as your dependents for tax purposes.

Predetermination of Benefits
Predetermination of benefits is required for a program of treatment, which the dentist estimates, will be more than $200.00. This provision does not apply to charges for emergency treatment. If a treatment plan is not submitted, the covered dental expense may be limited to the least expensive professionally recognized alternate procedures that will produce the same results. The pre-determination is not a guaranteed payment. The estimated benefits payable may change based on the benefits, if any, the person qualifies for when services are completed.

Claim forms are available at the Emory Human Resource Offices or by calling CompBenefits toll free at 1-800-407-5514. Any questions regarding claims should be directed to the toll free number listed above or email us at

Annual Maxiumum Benefit: $1,500 per insured
Annual Deductible: $50.00 per insured / $150.00 maximum per family

Type I: Diagnostic And Preventive   In- Network Out-of- Network
Deductible does not apply
X-ray- complete series including bitewings (1 per 36 months) 100% 100%
X-ray periapical-first film 100% 100%
X-ray panoramic 100% 100%
Diagnostic Casts 100% 100%
Initial oral examination (1 per 6 months) 100% 100%
Prophylaxis-adult (1 per 6 months) 100% 100%
Prophylaxis-child (1 per 6 months) 100% 100%
Topical application of fluoride (child) 100% 100%
Sealants per tooth 100% 100%
Emergency oral examination 100% 80%
Type II: Basic Services  In- Network Out-of- Network
Amalgam- 1 surface primary 90% 80%
Amalgam- 1 surface permanent 90% 80%
Amalgam- 3 surfaces permanent 90% 80%
Resin- 1 surface anterior 90% 80%
Single tooth extraction 90% 80%
Surgical removal of erupted tooth 90% 80%
Surgical extraction- fully bony impaction 90% 80%
Root recovery (surgical removal of residual root) 90% 80%
Replace broken teeth on denture-per tooth 90% 80%
Adding tooth to partial denture for extracted tooth 90% 80%
Periodontal prophylaxis ( 1 per 6 months) 90% 80%
Root planing- per quadrant 90% 80%
Root canal- one canal 90% 80%
Root canal-three canals 90% 80%
Apicoectomy 90% 80%
Type III: Major Services  In- Network   Out-of- Network 
Space maintainer-fixed unilateral type 50% 50%
Crown-porcelain fused to noble metal 50% 50%
Pontic- porcelain fused to noble metal 50% 50%
Recement bridge 50% 50%
Gingivectomy or gingivoplasty per quadrant 50% 50%
Gingival flap procedures- per quadrant 50% 50%
Complete upper or lower denture 50% 50%
Complete upper or lower partial dentures - Acrylic base with clasp/rests 50% 50%
Partial upper or lower denture adjustment 50% 50%
Type IV: Orthodontic Care 

Orthodontic care procedures are limited to eligible adult and dependent children under the age of 19. In-network and out of network benefits are payable at 50% of usual, customary, and reasonable fees. The lifetime maximum benefit is $1,500 per insured.





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