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2019 DMO Plan

Plan Type
Dental

The Dental Maintenance Organization (DMO) Plan provides in-network coverage only and requires selection of a primary care dentist to provide an integrated care experience and referrals to visit a specialist.

Features
  • Low contribution cost with high coverage levels
  • In-network providers only
  • In-network preventive, diagnostic, and basic services, e.g., examinations, visits, x-rays, cleanings, amalgam (silver) fillings, covered at 100%
  • Major services, e.g., crowns and implants, covered in-network at 60%
  • No coverage for out-of-network services
  • Orthodontia covered in-network at 50%
  • No annual deductibles or annual maximum benefit
  • Primary care dentist selected from the provider network
  • Referral to see a specialist required
  • Members pay the full cost of the premium for dental coverage
Coverage Options
In-Network
Plan Design
Employee
$25.15
Employee & Children
$49.05
Employee & Spouse
$50.72
Family
$70.09
In-Network
Individual
$0.00
Family
$0.00
In-Network
Individual
None
Preventive & Diagnostic Services

Examinations & Visits

In-Network
$0

X-Ray Services

In-Network
$0

Cleanings

In-Network
$0

Flouride Treatments

In-Network
$0
Basic Services

Amalgam (Silver) Fillings

In-Network
$0

Root Canal Therapy (Anterior Teeth)

In-Network
$0

Composite Fillings (Anterior Teeth)

In-Network
$0

Stainless Steel Crowns

In-Network
$0

Uncomplicated Extractions

In-Network
$0
Major Services

High Noble Metal & Porcelain Inlays

In-Network
40%

High Noble Metal Restorations

In-Network
40%

Crowns

In-Network
40%

Root Canal Therapy (Molars)

In-Network
40%

Implants

In-Network
40%
Orthodontia

Orthodontics

In-Network
50% / No lifetime maximum / Covers children and adults
Basis of Reimbursement

Reimbursement

In-Network
Negotiated fee
Additional Information

All benefits-eligible employees can elect coverage under the DMO Plan except Visiting Fellows.

ID cards are not provided for this plan as they are not required to obtain services.

Disclaimer

If there are any discrepancies between the information in this publication, verbal representations, and the plan documents, the plan documents always govern. Although Princeton intends to continue these benefits, the University reserves the right to amend or terminate these plans at any time.