SOLSTICE DENTAL PPO

SOLSTICE DENTAL PPO

From a cleaning, to dental implants Solstice dental offers members more than just basic care. With Solstice Dental PPO, all covered services In-Network are based on a percentage of the fi xed charges and varies whether the procedure is preventive, basic or a major service. Specialist referrals are not necessary In and Out-of-Network. If you choose to go Out-of-Network, most dentists will submit your claims directly to Solstice.

SOLSTICE DENTAL PPO

Rates are for new and renewing groups effective 4/1/2022 — 6/1/2022

PLAN RATES (MONTHLY)

Employee
$58.90
Employee/Spouse (DP)
$105.14
Employee/Child(ren)
$124.07
Family (DP)
$163.04

PLAN HIGHLIGHTS

  • Includes 4 cleanings in any 12 consecutive months
  • No referrals needed to see a specialist
  • $50 deductible for In-Network services/$50 deductible for Out-of-Network services
  • Annual maximum of $2,000
  • Implant benefit

Dental coverage can only be elected by a group enrolling in HealthPass medical coverage.
The following billing and administrative fees apply to the Solstice PPO plan: EE $9.25, EE/Spouse $18.25, EE+Child(ren) $16.50, Family $26.50.
Rates are subject to final verification at the time of enrollment.


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