| 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.
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PLAN A Full Plan for Employees and Family
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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 |
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Annual Deductible* Per Person Per Family |
$25 $75 |
$25 N/A |
$25 $75 |
Not Covered |
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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 |
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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.
More Details:
- Dental Benefits and How to File a Claim sections of the Plan Booklet
- Request for Reimbursement – Medical/Dental Benefits
- ASEA Health Trust Administrator
Phone: 1-866-553-8206 (toll-free)
Fax: 509-323-7614
Online: Contact Us
Mail: ASEA Health Benefits Trust, PO Box 5434, Spokane WA 99205-0434
