Dental Benefits

Deductible Per Benefit Period Per Covered Person $50

Type A (Preventive Care) Dental Expenses
Deductible Waived
Benefit Percentage 100%

Type B (Basic Care) Dental Expenses
Deductible Applies
Benefit Percentage 80%

Type C (Major Restorative) Dental Expenses
Deductible Applies
Benefit Percentage 50%

Maximum Benefit Per Benefit Period Per Covered Person $1,500
For type A, B, and C expenses combined

Orthodontia Benefit

For dependent children less than eighteen (18) years of age
Deductible Waived
Benefit Percentage 50%
Maximum Lifetime Benefit $1,500

A benefit period is the calendar year (1/1 - 12/31). HPM Health Plan uses the BCBSMT Traditional Dental Network and members may be balance billed if using nonparticipating providers.

Vision Benefits

Vision Exam $100
Every Benefit Period

Materials $200
Every Benefit Period

The limit may be used for frames, lenses, contact lenses, or disposable contacts

A benefit period is the calendar year (1/1 - 12/31). HPM Health Plan does not use a network for vision benefits.