POMCO Dental Plan
POMCO Dental Plan offers a wide variety dental insurance plans, and the type of plan you have depends on the contract your employer signed with them. Many of the plans follow similar structure – but yours may have specific conditions and exclusions not found in any other.
Annual Maximum Benefit –
Is what your POMCO Dental Plan will pay in any given insurance year. For Aetna, it is typically between $1500 and $2500. Most POMCO Dental Plans define INSURANCE YEAR from January 1 to December 31. Some plans, especially for school employees, may run on July 1-June 30 year. Check with your plan.
Annual Deductible –
what your POMCO Dental Plan wants you to pay before they cover anything. For POMCO , it is usually $50.
Coverage for Preventive procedures –
what your POMCO Dental Plan will pay for checkups, cleanings, X-rays, and sealants and fluoride for children. It is typically 100%, although some plans may pay less. Usually, the deductible does not apply.
Coverage for Cleanings and Checkups –
there are three types of frequencies allowed, twice a year, twice every 12 months, or once every 6 months. While they sound the same, they are actually very different.
Twice a year means twice every insurance year (typically January to December, but may be July to June, especially for school employees). Within that year, your insurance company will pay for 2 cleanings and checkups.
Twice every 12 months means your insurance company will pay for 2 cleanings and checkups every consecutive 12 months.
Once every 6 months means your insurance company will pay for one cleaning and checkup every 6 months to the day.
Coverage for Basic procedures –
what your POMCO Dental Plan will pay for fillings, root canals, gum treatments, and extractions. Most CSEA Dental Plans will cover 60-80% of the procedure costs. Sometimes, even though the plan says they will cover 80% of the procedure, their fees are so low that the actual coverage may be less.
Coverage for Major Procedures –
crowns, bridges, dentures. Typically, it is 50%, but it is subject to many provisions and restrictions, such as missing tooth clause, alternative minimum benefits, and others.
Coverage for Cosmetic Procedures –
veneers, teeth whitening, cosmetic bonding, adult orthodontics. No POMCO Dental Plan we have seen provides any coverage for these procedures.
Coverage for Dental Implants –
POMCO coverage varies greatly by the plan. Check with your carrier for specific information.
Please keep in mind that your plan may be completely different from the general guidelines we have provided here. We use a sophisticated computer system, Dentrix with Trojan Insurance Module, to help us get as much information as possible. Very often, we are able to tell you about your plan in great detail once we know who the employer is. Call us at 914 630 2833 for more information.
We know that when you look for an POMCO Dental Plan dentist in Harrison, Scarsdale, White Plains, Mamaroneck, or Rye, you have a wide selection.
We want you to know that when you select us for your dental care needs, you make the right choice!