Dental Plan Coverage Overview
Creighton offers a comprehensive dental plan focused on prevention and maintenance.
| TIER 1 | TIER 2 | TIER 3 |
|---|---|---|---|
|
Creighton Student Dental Clinic and Creighton Dental Associates |
UCCI Preferred Providers and CU Affiliated Dentists* |
Other Providers |
| Calendar Year Deductible | ||
Class A Services | NONE | NONE | NONE |
Class B Services | $25 | $50 | $75 |
Class C Services | $25 | $50 | $75 |
| Deductible applies to Class B and C Services Combined | ||
Percentage Payable | |||
Class A Services (Preventive) | 100% | 100% | 100% |
Class B Services (e.g. oral surgery, restoration, endodontics, periodontics) Note:some Class B Services will require pre-authorization | 85% | 70% | 50% |
Class C Services (e.g. bridges, crowns, dentures) Note:Class C Services require pre-authorization | 60% | 50% | 40% |
| |||
Maximum Calendar Year Benefit Per Person | Class A, B, and C Services Combined $1,000 | Class A, B, and C Services Combined $1,000 | Class A, B, and C Services Combined $750 |
|
| *as determined by the Dental School |
|
Dental Benefit: UCCI 1-866-454-3190 or www.dentabenefits.com
This general summary is presented as a matter of general information. This general summary is not to be accepted or construed as a substitute for provisions contained in the Plan documents held by the University. All statements made on this general summary sheet are subject to terms and provisions of the Plan and the policies and contracts of insurance funding the plan.