Page 48 - Takoma Park Benefits Guide 2022
P. 48

Dental Benefits




             TPSS Co-Op provides Dental benefits through the following dental plans through CareFirst.
             BlueDHMO Option 2


              » Must select a participating dentist from the DHMO network
              » /ŶͲEĞƚǁŽƌŬ benefits only

              » WůĞĂƐĞ ƌĞĨĞƌ ƚŽ ƐƵŵŵĂƌLJ ƉůĂŶ ĚĞƐĐƌŝƉƚŝŽŶ ĨŽƌ ŵŽƌĞ ĚĞƚĂŝůƐ ĂŶĚ ĨŽƌ ĐŽƐƚ ďƌĞĂŬĚŽǁŶ ƌĞĨĞƌ ƚŽ
               ͞&ƌĞƋƵĞŶƚůLJ  ƐŬĞĚ YƵĞƐƚŝŽŶƐ͘͟

             ĞŶƚĂů ^ƵŵŵĂƌLJ


                                  ĞŶĞĮƚƐ                                      BlueDHMO Option 2


                                                         /ŶͲEĞƚǁŽƌŬ
              ZĞĨĞƌƌĂů EĞĞĚĞĚ                                                         EŽ
               ůĂƐƐ /
                WƌĞǀĞŶƟǀĞͬ ŝĂŐŶŽƐƟĐ                                           Refer to Fee Schedule
               ůĂƐƐ //
                 ĂƐŝĐ ^ĞƌǀŝĐĞƐ                                                Refer to Fee Schedule
               ůĂƐƐ ///
                DĂũŽƌ ^ĞƌǀŝĐĞƐ Ͳ ^ƵƌŐŝĐĂů                                     Refer to Fee Schedule
               ůĂƐƐ /s
                                                                              Refer to Fee Schedule
                DĂũŽƌ ^ĞƌǀŝĐĞƐ Ͳ ZĞƐƚŽƌĂƟǀĞ
               ůĂƐƐ s
                KƌƚŚŽĚŽŶƟĐ ^ĞƌǀŝĐĞƐ Ͳ >ŝĨĞƟŵĞ DĂdžŝŵƵŵ                        Refer to Fee Schedule

               ĞĚƵĐƟďůĞ ; ůĂƐƐ //͕ /// Θ /sͿ
                /ŶĚŝǀŝĚƵĂů                                                   Refer to Fee Schedule
                &ĂŵŝůLJ
                                                      KƵƚͲŽĨͲEĞƚǁŽƌŬ

               ůĂƐƐ /
                WƌĞǀĞŶƟǀĞͬ ŝĂŐŶŽƐƟĐ                                                  N/A

               ůĂƐƐ //
                                                                                     N/A
                 ĂƐŝĐ ^ĞƌǀŝĐĞƐ
               ůĂƐƐ ///
                                                                                     N/A
                DĂũŽƌ ^ĞƌǀŝĐĞƐ Ͳ ^ƵƌŐŝĐĂů
               ůĂƐƐ /s
                                                                                     N/A
                DĂũŽƌ ^ĞƌǀŝĐĞƐ Ͳ ZĞƐƚŽƌĂƟǀĞ
               ůĂƐƐ s
                                                                                     N/A
                KƌƚŚŽĚŽŶƟĐ ^ĞƌǀŝĐĞƐ Ͳ >ŝĨĞƟŵĞ DĂdžŝŵƵŵ
               ĞĚƵĐƟďůĞ ; ůĂƐƐ //͕ /// Θ /sͿ
                /ŶĚŝǀŝĚƵĂů                                                           N/A
                &ĂŵŝůLJ
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