Faculty & Staff of the University of Pennsylvania

FY15 Plan Coverage FY15 Plan Documents

Employees of the UPenn Health System

FY15 Plan Coverage FY15 Plan Documents

Students of the University of Pennsylvania

FY15 Plan Coverage FY15 Plan Documents

Penn Dental Plan for Students of the University of Pennsylvania

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.

  • 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.

Category

Coverage

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).

100%

Restorative Care

Composites (tooth-colored fillings); co-pays may apply on certain procedures.

100%

Oral Surgery

Typically covered under your medical plan. For complex extractions, a co-pay may apply.

100%

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.

80%

Prosthodontics

Crowns, bridges, inlays, and dentures.

50%

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)

50%

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).

50%

Occlusal Nightguards

50%