DENTAL

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The following is a summary of your dental benefits. For a more detailed explanation of benefits, please refer to your Summary Plan Description (SPD), certificate of coverage or benefit summary. There is no network for dental coverage, which means you have open access to see any provider in your area. The provider just needs to reach out to EBMS for benefit and eligibility verification.

Process Technology’s benefit plans deductibles and out of pocket maximums are based on a calendar year. Each January 1st, a new deductible amount is required, and the deductible will apply to the maximum out-of-pocket amount.

www.ebms.com
866-326-7598

	Open Access
Deductibles*
Per plan participant	$50
Per family unit	$100
Maximum Benefit
Class A, B, & C Services	$1,000 per calendar year
Class D Services	$1,000 per lifetime
Class A – Preventive
Routine exams, bitewing x-rays, sealants	100%, no deductible applies
Class B – Basic
Panoramic x-rays, endodontic procedures, extractions	80% after deductible
Class C – Major
Inlays, onlays, crowns, prosthetics	50% after deductible
Class D – Orthodontia
Orthodontic services (under age 19)	50%, no deductible applies

*Applies to class B & C.

DENTAL

DENTAL

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Dental Insurance