What Does it Cost? EMPLOYEE ONLY $17.95* EMPLOYEE & SPOUSE $33.89* EMPLOYEE & CHILD(REN) $39.02* EMPLOYEE & FAMILY $54.64* * Premiums effective January 1, 2024 - December 31, 2025 and based per pay period.

Featured Benefits: You pick the dentist Competitive rates Easy enrollment – we take the work out of enrolling Pays 100% of preventative services (First year: 80%; Thereafter: 100%) No waiting periods Carryover Benefit Rider – A portion of your unused annual maximum is available for future expenses.

How does it work?

• A $50 annual deductible (applies to Classes 2 & 3 only, max. 3 per family).
• Annual maximum of $1,000 per person.
• No waiting periods.
• Carryover Benefit Rider – A portion of your unused annual maximum is available for future expenses. Click Here for further details.

Payments increase in the first three years you are in the plan and are based on reasonable and customary charges of your area, with the following adjustments per person:

YEAR 1 YEAR 2 YEAR 3 PREVENTIVE (CLASS 1) 80% 100%* 100%* BASIC (CLASS 2) 50% 65% 80% MAJOR (CLASS 3) 25% 35% 50% ORTHODONTIA (CLASS 4) 25% 35% 50%

* Preventive services are paid at 100% of maximum allowable (years 2 and 3).

Dependent children are covered to the end of the year after they turn 26.

Minimal Paperwork Required: 90% of claims are submitted by dentists directly to Starmount.

How do I enroll? It is easy!

1. Call us toll-free at 1-888-400-9303.
2. Click here to proceed to the enrollment process.

Takeover Benefits:

If you already have dental insurance through the State Uniform Payroll System, and choose to elect Starmount’s program, we will give you credit for the time you have had coverage with your prior carrier. Example: If you have been on another State-sponsored plan for one year, you would be eligible for year two of benefits with Starmount. Takeover benefits are available only to those individuals insured under another State-sponsored dental insurance plan in effect at the time of your application (excludes discount plans)."

You must provide prior carrier’s "Explanation of Benefits" forms to verify Orthodontic procedures completed under the prior plan in order for payments to be made.

The prior carrier is responsible for reimbursement of costs for procedures begun prior to the effective date.

SUMMARY OF COVERED PROCEDURES
DEDUCTIBLE	$50 per benefit year. Maximum 3 per family. Does not apply to Preventive (Class 1) or Orthodontia (Class 4) Services.
BENEFIT YEAR MAXIMUM	$1000 per benefit year (Includes Class 1, 2, 3, and 4 Services)
CLASS 1 PREVENTIVE SERVICES	Routine exams (2 per 12 months) Prophylaxis (2 per 12 months**) Space maintainers for children up to age 16 Sealants for children up to age 16 Full mouth/Panoramic x-rays (1 per 24 months) Bitewing X-rays (max 4 films; 1 per 12 months) Fluoride for children up to age 16 (1 per 12 months) Adjunctive Pre-Diagnostic Oral Cancer Screening (1 per 12 months for age 40+)
CLASS 2 BASIC SERVICES	Emergency treatment Simple restorative services (fillings) Simple extractions Denture and crown repair Oral surgery (extractions and impacted teeth) including anesthesia
CLASS 3 MAJOR SERVICES	Crowns, Bridges, Dentures and Endosteal Implants Endodontics (Root Canals) Periodontics (Gum Treatment)
CLASS 4 ORTHODONTICS	Dependent children to age 19 only Annual maximum benefit: $500 Lifetime maximum benefit: $1,000

^** One additional cleaning or periodontal maintenance per 12 months, if member is in second or third trimester of pregnancy.

Services Not Listed:

If you expect to require a dental service not listed above, it may still be covered. Please contact our Dental Team at 1-888-400-9303 to confirm your exact benefits.

Preauthorization of Claims: Starmount recommends preauthorization of any services expected to cost $300 or more.

---

Summary of Limitations & Exclusions

Exclusions: The following services are not covered.

Members whose dental plan includes coverage of crowns and bridges will have the option of choosing an endosteal implant to replace a missing tooth instead of a conventional fixed 3-unit bridge, when a 3-unit bridge is approved for coverage. Crowns placed on implants will also be covered. Other implants or implant related services are not covered. Any treatment which is elective or primarily cosmetic in nature and not generally recognized as a generally accepted dental practice by the American Dental Association, as well as any replacement of prior cosmetic restorations; Multiple x-rays done on same date of service will be combined to a full-mouth x-ray; Cosmetic restorations on posterior permanent teeth and all primary teeth will be given alternate benefit; Anesthesia is covered with complex oral surgery only.Charges are subject to review. Pre-treatment estimate is recommended; The correction of congenital malformations; The replacement of lost or discarded or stolen appliances; Replacement of bridges, dentures, crowns, inlays, onlays or dentures unless more than five [5] years old and cannot be made serviceable; Appliances, services or procedures relating to: (i) the change or maintenance or vertical dimension; (ii) restoration of occlusion; (iii) splinting; (iv) correction of attrition, abrasion, erosion or abfraction; (v) bite registration or (vi) bite analysis; Services provided for any type of temporomandibular joint (TMJ) dysfunctions, muscular, skeletal deficiencies involving TMJ or related structures, myofascial pain; Charges for: implants of any type, and all related procedures (except noted above), removal of implants, precision or semiprecision attachments, denture duplication, overdentures and any associated surgery, or other customized services or attachments; Dentures, bridges, implants and partials for teeth missing prior to effective date of coverage. Some exceptions apply and are detailed in the Certificate of Coverage. Any procedure begun or appliance installed before an insured became insured under the policy