Dental
Preventive care is covered in full. Your annual maximum is $2,000, and it resets every January 1 with your plan year.
What comes out of your paycheck
Apex pays 82.5% of the dental premium.
| Coverage tier | Your cost per paycheck |
|---|---|
| Employee Only | $4.37 |
| Employee + Spouse | $10.01 |
| Employee + Child(ren) | $9.27 |
| Employee + Family | $13.03 |
Plan design
Deductible and maximum
- Deductible, per member
- $50
- Deductible, per family
- $150
- Annual maximum, per member
- $2,000
- Waiting period
- None
The annual maximum runs on a calendar year and resets January 1, the same day as your medical plan year.
What the plan pays
- Preventive and diagnostic
- Full coverage
- Basic services
- 80%
- Major services
- 50%
- Orthodontia
- 50%
Preventive care is covered in full and does not draw on your deductible — cleanings and exams cost you nothing in network.
Orthodontia
Covered at 50%, to age 19, with no deductible applied. Lifetime maximum of $1,500.
If you are planning braces for a child, the age limit and the lifetime maximum are the two figures that matter most — the maximum applies across the lifetime of the coverage, not per year.
You can bank unused dental benefit for later
Your plan includes the Dental Blue Accumulated Maximum Rollover. Unused annual benefit rolls forward, building a reserve for the year you need expensive work.
How much rolls over
Apex’s annual maximum is $2,000, which puts you in the $2,000–$2,499 band:
- If your total claims stay under
- $800
- Amount rolled over
- $600
- Rollover total is capped at
- $1,500
Your rollover balance keeps growing year to year. Build it to the cap and your available maximum reaches $3,500 in a year you need it.
Rollover is added 60 days after the last day of the benefit period. There is no cost and nothing to sign up for.
You have to use the plan a little to bank anything
Two conditions, and they pull in opposite directions:
- You must receive at least one covered service during the benefit period
- Your total claims must not exceed $800
So skipping the dentist entirely earns you nothing. Going for your two covered cleanings and an exam — which cost you nothing in network — is what banks the $600.
You must also remain a member of the plan throughout the benefit period.
This is not a spending account
Rollover increases your benefit maximum for future years. It is not money in an account and it is not an FSA — there is nothing to claim or spend directly.
It also depends on Apex continuing to offer the rollover benefit.
Plan documents
Dental Blue Program 2 with Orthodontics — Summary of Benefits, Blue Cross Blue Shield of Massachusetts.
Enhanced dental benefits
Members with certain qualifying medical conditions can receive additional preventive and periodontal coverage at no additional cost, not subject to the deductible, coinsurance or annual maximum.