PEBB 2008 Benefit Changes
Premier and PPO product – Full time employees
- Annual benefit maximum from $1,500 to $1,750
- Ortho lifetime maximum from $1,000 per person to $1,500
- Add coverage for implants with 50% (part of regular annual max)
- Increase crown benefit to 75% (If questioned: this is crown only, not other items)
- Reduce the frequency for possible replacement of crowns, inlays, onlays and prosthetic replacement to 7 years
- Reduce frequency on root planing to once every 24 months
- X-ray changes:
Adults (15 and older)– bitewings 1 per 2 calendar years, full-mouth or pano every 5 years
Children (younger than 15) – bitewings every calendar year, full-mouth or pano every 5 years - Exam & Fluoride 2 per calendar year (was per 6 months)
Benefit based on specific provider assessment and documentation in their chart notes:
- One prophy per calendar year as starting benefit.
- Additional prophy or perio maintenance will be approved for patients qualified based on provider assessment a patient may have 2 per year or up to 4 per year.
Part time & Retirees
- Annual benefit maximum from $1,000 to $1,250
- Decrease the frequency for possible replacement of crowns, inlays, onlays and prosthetic replacement to 7 years
- Reduce frequency on root planing to once every 24 months
- X-ray changes:
Adults (Members 15 and older)–bitewings 1 per 2 calendar years, full-mouth or pano every 5 years
Children (Members younger than 15) – bitewings every 12 months, full-mouth or pano every 5 years - Exam & Fluoride 2 per calendar year (was per 6 months)
Benefit based on specific provider assessment and documentation in their chart notes:
- Prophy one general cleaning per member per year as starting benefit.
- Additional prophy or perio maintenance will be approved for patients qualified based on specific provider assessment and documentation in their chart notes, depending on risk factor patient may have 2 per year or up to 4 per year.
Italic – only applies to full time employees