DENTAL

	Coverage Includes
Deductible	$25 single / $75 family
Annual Maximum Benefit	$3,000
Preventive Care Services
Bitewing X-Rays, Cleanings, Exams/Evaluations, Fluoride Treatments, Diagnostic X-Rays, etc.	100% of UCR
Basic Care Services
Endodontics, Periodontal Services, Dentures, Crown Repairs, Extractions, Impactions, Oral Surgery, Anesthesia, etc.	80% of UCR after deductible
Major Care Services
Inlays, Onlays, Crowns, Major Restorative Services, etc.	80% of UCR after deductible
Orthodontia Services	60% to $2,000 Lifetime Maximum

Employee Level	Monthly
Single	$16.09
Family	$39.68

Resources

2025 Schedule of Benefits

Dependents

Dependents can be covered until the end of the month in which they reach age 26. A dependent is not required to be a student; they can be married or have a job that offers insurance. If the dependent is your child, that dependent can remain covered to the age of 26.

Network

Superior Dental Care Network providers agree to accept Medical Mutual’s allowed amount plus any patient responsibility (deductible/coinsurance) as payment in full.

You have the option to choose any dentist and receive the benefits listed below. If you choose to receive covered dental services from a dentist who participates in the Superior Dental Care Network, you will not receive balance bills (the difference between the amount paid by Medical Mutual and the provider’s billed amount).

To find a Superior Dental Care Network provider:
1. Go to www.medmutual.com
2. Click “Find a Provider”
3. Click “Dental”
4. Select “Superior Dental Care” Network
5. Enter search requirements
6. Or Call 800-752-1547

Premium Holiday

If eligible, there will be two premium holidays announced during the year where no premium will be deducted your paycheck.