2026 AtlantiCare Benefits Booklet

DENTAL BENEFITS (CONT.)

WELCOME....................................2 WHAT’S NEW..............................3 HOW TO ENROLL......................4 HEALTHCARE TRANSFORMATION CONSORTIUM (HTC)...............6 GETTING TO KNOW YOUR PLAN.................................7 MEDICAL......................................8 PRESCRIPTION DRUG.......... 17 FQHC........................................... 19 ADDITIONAL MEDICAL PLAN RESOURCES................. 20 WELLNESS PROGRAM......... 21 DENTAL...................................... 23 VISION........................................ 25 LIFE INSURANCE.................... 28 DISABILITY............................... 30 VOLUNTARY OFFERINGS... 31 EDUCATIONAL SUPPORT & CAREER DEVELOPMENT...................... 31 FINANCIAL WELL-BEING.... 32 HEALTH &WELLNESS.......... 33 SAVINGS.................................... 34 VOLUNTARY BENEFITS....... 35 SPENDING ACCOUNTS............................... 38 RETIREMENT BENEFITS................................... 39 CONTACTS................................ 41 LEGAL NOTICES....................... 43 WELLNESS CHECKLIST........ 45

Summary of Dental Benefits

Dental Plus Ortho Plan*

Summary of Services

Basic Dental Plan

Preventive (routine exams, xrays, cleanings)

100%

100%

Basic Care (fillings, extractions, periodontal)

70%

90%

Major Care ( crowns, dental implants, dentures)

50%

60%

50% $1,000 annual maximum

60% $1,500 annual maximum 60% $2,000 lifetime maximum

Implants, subject to annual maximum per patient

Orthodontics* subject to a lifetime maximum per person

0%

Annual Maximum Per Individual

$1,500

$2,500

Annual Deductible Amount Per Person

$25

$25

Annual Deductible Amount Per Family

$75

$75

*Orthodontia coverage is only available if enrolled in the plan prior to the initial orthodontia appointment for braces. *Youmust continue to be enrolled in the “Dental Plus Ortho” plan for the entire time of orthodontia services as payments are on a pro-rated basis.

Bi-Weekly & Annualized Employee Dental Cost

Bi-Weekly Cost

Bi-Weekly Cost

Coverage Type

For Basic

For Plus Ortho

Employee

$2.60

$9.36

Employee/Child or Employee + Spouse

$5.20

$22.88

Family

$7.80

$26.00

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