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.
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.
Penn Dental Plan for University Employees and DependentsPDFP Dental Plan for Faculty & Staff of the University of Pennsylvania.
Maximum Annual Coverage Per Individual: $3,000.
Routine examinations and prophys/cleanings (twice annually), Radiographs, fluoride applications and sealants (for children up to age 14).
Composites (tooth-colored fillings); co-pays may apply on certain procedures.
Typically covered under your medical plan; for complex extractions, a co-pay may apply.
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.
Crowns, bridges, inlays, and dentures
Implant surgery is covered at 50% and crown restoration is covered at 60%. Other components not covered such as bone & abutment may be required.
One orthodontic treatment per lifetime for children and adults, subject to a maximum $2,000 benefit.
Bleaching is excluded from the Cosmetic benefit, although the fee has been significantly reduced. Occlusal Nightguards limited to 1 in 5 years.
Penn Dental Plan for UPHS Employees and DependentsDental Plan for University of Penn Health System Employees and Dependents.
Maximum Annual Coverage Per Individual: $3,000.
Annual Deductible: $50/person ($150/family)
Routine examinations and prophys/cleanings (twice annually), Radiographs, fluoride applications and sealants (for children up to age 14).
Composites (tooth-colored fillings); co-pays may apply on certain procedures.
Typically covered under your medical plan; for complex extractions, a co-pay may apply.
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.
Crowns, bridges, inlays, and dentures
Implant surgery is covered at 50% and crown restoration is covered at 60%. Other components not covered such as bone & abutment may be required.
One orthodontic treatment per lifetime for children and adults, subject to a maximum $2,000 lifetime benefit.
Occlusal Nightguards limited to 1 in 5 years.
Penn Dental Plan for Students of the University of PennsylvaniaDental Plan for Students of the University of Pennsylvania.
Maximum Annual Coverage Per Individual: $1,500.
Annual Coverage Per Individual: $1,500 / Annual Premium Cost: $429 / Annual Deductible: $50
Routine examinations and prophys/cleanings (twice annually), Radiographs, fluoride applications and sealants (for children up to age 14).
Composites (tooth-colored fillings); co-pays may apply on certain procedures.
Typically covered under your medical plan; for complex extractions, a co-pay may apply.
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.
Crowns, bridges, inlays, and dentures
Implant surgery is covered at 50% and crown restoration is covered at 50%. Other components not covered such as bone & abutment may be required
One orthodontic treatment per lifetime for children and adults, subject to a maximum $1,500 benefit.
Occlusal Nightguards.
Get Your Appointment Now
We look forward to serving you and your family.