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Penn Dental Plan for Students of the University of Pennsylvania

Annual Coverage Per Individual: $1,500
Annual Premium Cost: $399
Annual Deductible: $50

(Deductible is not applied for preventive & diagnostic procedures)

Spouses and dependents of students are also eligible to sign up for the plan at the rates and coverage above. Each enrollee receives $1,500 in coverage.

The following chart reflects a summary of the coverage for information purposes only. Please refer to the Plan Document for detailed coverage including limitations and exclusions.

FY 16 FOR STUDENTS OF THE UNIVERSITY OF PENNSYLVANIA
Insurance Plan Coverage
penn_0003_Group-6
Diagnostic and Preventive Care
Routine examinations and prophys/cleanings (limited to not more than two times in a 12 month period), radiographs, fluoride applications and sealants (for children up to age 14).
penn_0002_Group-7
Oral Surgery
Typically covered under your medical plan; for complex extractions, a co-pay may apply.
penn_0000_Group-4
Prosthodontics
Crowns, bridges, inlays, and dentures
penn_0000_Group-4
Orthodontics – including Invisalign.
One orthodontic treatment per lifetime for children and adults, subject to a maximum $1,500 benefit. This includes a one-time Invisalign benefit of $1,500 (full case) or $750 (limited express case).
penn_0002_Group-7
Restorative Care
Composites (tooth-colored fillings); co-pays may apply on certain procedures.
penn_0002_Group-7
Endodontics & Periodontics
Endo: Root canal therapy, pulp treatment, pulpotomy, apicoectomy. Perio (gum treatment): Surgical and non-surgical periodontics including subgingival curettage, scaling and root planing, periodontal maintenance.
penn_0000_Group-4
Implant Surgery
Implant surgery is covered at 50% and crown restoration is covered at 50%. Other components not covered such as bone & abutment may be required
penn_0000_Group-4
Occlusal Nightguards
cta-oral-b

FREE TOOTHBRUSH OFFER

Present to Penn Dental as a new patient and receive a complimentary Oral B Power Toothbrush with this ticket!