ASEA AFSCME Local 52 Health Benefits Trust is in Alaska

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The ASEA Health Trust’s Dental Plan covers diagnostic and preventive services, basic and major restorative services, as well as prosthetics such as inlays, crowns, implants, bridges and dentures. You may receive care from any licensed dental practitioner.

If your dental provider is not able to submit a claim for their service; use the Request for Reimbursement – Medical/Dental Benefits to submit a claim.

Amount Covered by Plan Option

The amount the Plan pays for dental care is based on the Allowable Expenses of the Medical Plan Option in which you are enrolled.

 

PLAN A

Full Plan for Employees and Family

 

PLAN B

Full Plan for Employees Only

PLAN C

Supplemental Plan for Employees and Families with Other Coverage

PLAN D

Low Option Plan for Employees and Families

Annual Deductible*

Per Person

Per Family

 

$25

$75

 

$25

N/A

 

$25

$75

 

Not Covered

Reimbursement Percentage

Preventive

Restorative

Prosthetic

 

 

Plan pays 100%

Plan pays 85%

Plan pays 50%

 

 

Plan pays 100%

Plan pays 85%

Plan pays 50%

 

 

Plan pays 100%

Plan pays 85%

Plan pays 50%

 

 

Not Covered

Not Covered

Not Covered

Annual Maximum Plan Benefit**

 

$2,000

 

$2,000

 

$2,000

 

N/A

* Deductible does not apply to preventive services.
** Benefits paid for preventive services does not apply to the $2,000 annual maximum plan benefit.

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