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Bigger Value For A Brighter Smile.

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.

  • Issue ages: 18 to Any Age
  • Dependent children age: Last day of the year they turn 26
  • Plan includes $7,000 term life
Enrollment Deadline 18th of the month prior to effective date
Provider Lookup (Solstice PPO) http://www.solsticebenefits.com/provider-search.aspx (Solstice PPO)
Find a Dental Provider (How To) PDF
Plan Summary & Limitations, Non-Covered Services, and Exclusions PDF

NON-ORTHODONTICS

Individual Annual Calendar Year Deductible

  • $50
  • $50

Family Annual Calendar Year Deductible

  • $150
  • $150

Maximum (the sum of all Network and Out-of-Network benefits will not exceed Maximum Benefits)

  • $1500 per person per Calendar Year
  • $1500 per person per Calendar Year

ORTHODONTICS

Individual Annual Calendar Year Deductible

NOT COVERED
Annual 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

COVERED SERVICES

PREVENTIVE & DIAGNOSTIC SERVICES

NETWORK PLAN PAYS*

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%

OUT-OF-NETWORK PLAN PAYS**

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%

BENEFIT GUIDELINES

Periodic Oral Evaluation:

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

BASIC SERVICES

NETWORK PLAN PAYS*

Restorations (Amalgam or Composite) 80%
Simple Extractions 80%
Oral Surgery (includes surgical extractions) 50%
Periodontics 50%
Endodontics 50%
Anesthetics 80%
Adjunctive Services 80%

OUT-OF-NETWORK PLAN PAYS**

Restorations (Amalgam or Composite) 80%
Simple Extractions 80%
Oral Surgery (includes surgical extractions) 50%
Periodontics 50%
Endodontics 50%
Anesthetics 80%
Adjunctive Services 80%

BENEFIT GUIDELINES

Restorations (Amalgam or Composite) :

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.

MAJOR SERVICES (12 Month Waiting Period)

NETWORK PLAN PAYS*

Inlays/Onlays/Crowns 50%
Dentures and other Removable Prosthetics 50%
Fixed Partial Dentures (Bridges) 50%

OUT-OF-NETWORK PLAN PAYS**

Inlays/Onlays/Crowns 50%
Dentures and other Removable Prosthetics 50%
Fixed Partial Dentures (Bridges) 50%

BENEFIT GUIDELINES

Inlays/Onlays/Crowns:

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

ORTHODONTIC SERVICES

NETWORK PLAN PAYS*

Diagnose or correct misalignment of the teeth or bite Not Covered

OUT-OF-NETWORK PLAN PAYS**

Diagnose or correct misalignment of the teeth or bite Not Covered

BENEFIT GUIDELINES

Diagnose or correct misalignment of the teeth or bite

Not Covered











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