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% | ||
| Orthodontia (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.