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Jackson Memorial Hospital
Dental Members |
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OHS Enriched Plan 400 Schedule of Benefits1
The co-payments listed are the maximum fees that will be charged by the Participating General
Dentist for the specified covered services.
| 1Select a service below |
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| Services |
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Specialist Care
All dental procedures will be provided to the member in
accordance with the Plan Benefits Schedule as long as that procedure is within the scope and
competence of general dental (i.e., certain oral surgery, endodontics, periodontics, pedodontics),
the member will be referred to a participating specialist (where participating
specialists are
available), and receive a 25% discount from the usual, customary and reasonable (UCR) fees
of the specialist. |
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Note
Cosmetic procedures and
procedures not listed o the Plan
Benefits Schedule will be provided at the participating dentist's usual, customary and
reasonable (UCR) fees less 25%. |
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