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 (waived for Preventive Services)||$50 individual / $100 family||None|
|Annual Benefit Maximum||$1,750||$2,500|
Diagnostic and Preventive Services
|Covered in full||Covered in full|
Basic Restorative Services
|20% after deductible||20%|
Other Basic and Major Services
|50% after deductible||20%|
(adults and children)**
|50% after deductible||50%|
|Orthodontia Lifetime Maximum||$1,500 per person||$1,750 per person|
* For out-of-network services, members pay applicable coinsurance plus any amount that exceeds the usual, customary, and reasonable charge.
** With an approved orthodontia treatment plan. Not all adult orthodontia is covered, for example an adult who wants a replacement retainer might not get the retainer covered.