STUDENTS
PARENTS
DENTAL OPTIONS
STUDENTS
PARENTS
DENTAL OPTIONS

BECAUSE MOM CAN'T HELP WITH A TOOTHACHE.

Dental problems can often lead to time spent sitting in a dentist’s chair instead of the classroom.

With the RIT Student Dental Plan, you’ll have access to hundreds of local dentists at convenient locations.
Spend less time worrying about cavities and tooth pain, and more time making the Dean’s List.

With the RIT Student Dental Plan, you’ll have access to hundreds of local dentists at convenient locations. Spend less time worrying about cavities and tooth pain, and more time making the Dean’s List.

STUDENTS

Send your parents an email! Simply enter your parents' email address and we'll send a message about RIT Student Dental or visit the Student Health Center office (August Center, Building 23-A) to complete an enrollment form.

PARENTS

2. Return the form to:

Attn: Membership and Billing
Excellus BlueCross BlueShield
P.O. Box 21146
Eagan, MN 55121-0146

Do not send premium payment with your enrollment form. You will be billed.
For questions or more information, please contact Customer Service: 1-800-724-1675, TTY 1-800-421-1220, 8:00 a.m. – 5:30 p.m. (Mon. – Th.), 9:00 a.m. – 5:30 p.m. (Fri.)

DENTAL BLUE OPTIONS

OPTION A

In/Out of Network Coverage

OPTION B

In/Out of Network Coverage

Preventive/ Diagnostic

80%/80%

100%/100%

Examinations, cleanings (prophylaxis), bitewing x-rays, full-mouth panorex x-rays, fluoride treatments*, space maintainers*, sealants* (*Age restrictions may apply.)
Basic Restorative

50%/50%

80%/80%

Amalgam fillings, composite fillings, routine/simple extractions

Basic Restorative (Enhanced)

0%/0%

80%/80%

Oral surgery including impacted wisdom teeth removal, anesthesia/IV sedation, root canal treatment, periodontal surgery, periodontal scaling and root planing, periodontal maintenance following surgery
Major Restorative

0%/0%

60%/60%

Inlays/onlays/crowns, fixed prosthetics: bridgework, abutments, pontics, removable prosthetics: partial dentures, complete dentures, denture: relines, rebases, repairs, implants
Orthodontia (Braces)

0%/0%

50%/50%/$1000 MAX

ANNUAL MAXIMUM

$500

$1,000

Annual Cost

OPTION A

OPTION B

Single

$252.84

$580.20

Student/Spouse

$416.52

$956.16

Student/Child

$416.40

$956.04

Student/Children

$401.52

$921.48

Family

$564.96

$1,297.08

Fall enrollment 9/1/17-10/15/17. Spring Enrollment 1/1/18-2/15/18. Coverage effective through 8/31/18.