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Dental Benefits Summary: The Flexible Choice Plan

Benefit	Coverage
Calendar Year Deductible	None.
Calendar Year Maximum	In-Network: Plan pays up to $900 per person per calendar year toward all covered expenses. Out-of-Network: Plan pays up to $750 per person per calendar toward all covered expenses. Note: The calendar year maximum does not apply to pediatric oral care.
Preventive Care Services
Oral exams and routine cleanings: twice in a calendar year Bitewing x-rays and fluoride applications for children under 19: once per calendar year Sealants for dependent children: once every three consecutive calendar years Full mouth x-rays: once every three consecutive calendar years Brush biopsy to detect oral cancer Emergency treatment to relieve pain Cleanings following periodontal therapy	In- and Out-of-Network: Plan pays 100% of covered expenses, up to the *reasonable and customary charge*. There is no deductible.
Note: Dental coverage under the Flexible Choice Plan is for preventive care services only. There is no coverage for non-preventive services.

Dental Benefits Summary: The Building Trades Plan