PEBB 2008 Benefit Changes

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.

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