Quality, affordable dental care... It's that simple. Solstice dental plans offer rich plans and unbeatable savings with the security of knowing that you will be protected from hidden fees and surprises. Plus, our large open-access provider network means that you'll never have to deal with frustrating roster restrictions again. Now that's something to smile about.
Enrollment Deadline | 18th of the month prior to effective date |
Provider Lookup (Solstice PPO) | http://www.solsticebenefits.com/provider-search.aspx (Solstice PPO) |
Plan Summary & Limitations, Non-Covered Services, and Exclusions |
Individual Annual Calendar Year Deductible
Family Annual Calendar Year Deductible
Maximum (the sum of all Network and Out-of-Network benefits will not exceed Maximum Benefits)
Individual Annual Calendar Year Deductible
NOT COVEREDAnnual deductible applies to preventive and diagnostic services | No (In Network) No(Out-of-Network) |
Solstice BenefitsBooster Included (Increasing Calendar Year Maximum Benefit) | Yes |
Preventive Waiver Saver Included (P&D Services Do Not Accumulate Towards Annual Maximum) | No |
Orthodontic eligibility requirement | N/A |
Periodic Oral Evaluation | 100% |
Routine Radiographsn | 100% |
Non-Routine - Complete Series Radiographs | 100% |
Prophylaxis (Cleanings) | 100% |
Fluoride Treatment | 100% |
Sealants | 100% |
Space Maintainers | 100% |
Palliative Treatment | 100% |
Periodic Oral Evaluation | 100% |
Routine Radiographsn | 100% |
Non-Routine - Complete Series Radiographs | 100% |
Prophylaxis (Cleanings) | 100% |
Fluoride Treatment | 100% |
Sealants | 100% |
Space Maintainers | 100% |
Palliative Treatment | 100% |
Limited to two (2) times per consecutive twelve (12) months.
Routine Radiographs: Bitewings:Bitewings: Limited to one (1) series of films per consecutive twelve (12) months.
Non-Routine - Complete Series Radiographs:Complete Series/Panorex: Limited to one (1) time per consecutive thirty-six (36) months.
Prophylaxis (Cleanings):Limited to (2) prophylaxis in any twelve (12) consecutive months, to a maximum of (2) total prophylaxis and periodontal maintenance procedures in any twelve (12) consecutive months.
Fluoride Treatment:Limited to Covered Persons under the age of sixteen (16) years, and to one (1) time per consecutive twelve (12) months.
Sealants:Limited to Covered Persons under the age of sixteen (16) years, and to one (1) time per first or second unrestored permanent molar every consecutive thirty-six (36) months.
Space Maintainers:Limited to Covered Persons under the age of sixteen (16) years, one (1) time per consecutive sixty (60) months. Benefit includes all adjustments within six (6) months of installation.
Palliative Treatment:Covered as a separate benefit only if no other service, other than exam and radiographs, were done during the visit
Restorations (Amalgam or Composite) | 80% |
Simple Extractions | 80% |
Oral Surgery (includes surgical extractions) | 50% |
Periodontics | 50% |
Endodontics | 50% |
Anesthetics | 80% |
Adjunctive Services | 80% |
Restorations (Amalgam or Composite) | 80% |
Simple Extractions | 80% |
Oral Surgery (includes surgical extractions) | 50% |
Periodontics | 50% |
Endodontics | 50% |
Anesthetics | 80% |
Adjunctive Services | 80% |
Multiple restorations on one (1) surface will be treated as a single filling.
Simple Extractions:Limited to one (1) time per tooth per lifetime.
Oral Surgery (includes surgical extractions):Extractions: Limited to one (1) time per tooth per lifetime.
Periodontics:Periodontal Surgery: Limited to one (1) quadrant or site per consecutive thirty-six (36) months per surgical area. Scaling and Root Planing: Limited to one (1) time per quadrant per consecutive twenty-four (24) months.
Periodontal Maintenance: Limited to two (2) periodontal maintenance in any twelve (12) consecutive months, to a maximum of two (2) total prophylaxis and periodontal maintenance procedures in any twelve(12) consecutive months.
Anesthetics:General Anesthesia: When clinically necessary.
Inlays/Onlays/Crowns | 50% |
Dentures and other Removable Prosthetics | 50% |
Fixed Partial Dentures (Bridges) | 50% |
Inlays/Onlays/Crowns | 50% |
Dentures and other Removable Prosthetics | 50% |
Fixed Partial Dentures (Bridges) | 50% |
Limited to one (1) time per tooth per consecutive sixty (60) months.
Dentures and other Removable Prosthetics:Full Denture/Partial Denture: Limited to one (1) per consecutive sixty (60) months. No additional allowances for precision or semi precision attachments.
Fixed Partial Dentures (Bridges):Bridges: Limited to one (1) time per tooth per consecutive sixty (60) months
Diagnose or correct misalignment of the teeth or bite | Not Covered |
Not Covered