Dental coverage for employees residing in Hawaii is provided through the HMSA medical PPO Plan. Visit the Hawaii Employee Benefits page of this site to learn more.
| Dental Standard | Dental Enhanced | |||
|---|---|---|---|---|
| IN-NETWORK | OUT-OF-NETWORK * | IN-NETWORK | OUT-OF-NETWORK * | |
| Annual Deductible | $50 individual / $100 family | None | ||
| Annual Benefit Maximum | $1,750 per person | $2,500 per person | ||
| Orthodontic Lifetime Benefit Maximum | $1,500 per person | $1,750 per person | ||
|
Diagnostic and Preventive Services
|
Covered in full | Covered in full | Covered in full | Covered in full |
|
Basic Restorative Services
|
Anthem pays 80% after deductible | Anthem pays 80% after deductible | Anthem pays 80% | Anthem pays 80% |
|
Other Basic and Major Services
|
Anthem pays 50% after deductible | Anthem pays 50% after deductible | Anthem pays 80% | Anthem pays 80% |
| Orthodontia (adults and children) |
Anthem pays 50% after deductible | Anthem pays 50% after deductible | Anthem pays 50% | Anthem pays 50% |
| Orthodontia Lifetime Maximum | $1,500 per person | $1,500 per person | $1,750 per person | $1,750 per person |
* Out-of-network coverage is based on the maximum allowed amount determined by Anthem. You may pay more out of pocket for providers that are not in the Anthem network.