Dental Benefits

Xavier offers two dental plans through Superior Dental Care (SDC). The dental plans cover routine cleanings and can help offset additional expenses from basic to major services 

 

In-Network Coverage

Open Access Network
In-Network Benefits Core Plan Enhanced Plan

Deductible (Calendar Year)

$50 single, $150 maximum per family* $50 single, $150 maximum per family*
Annual Maximum (Calendar Year) $1,000 per plan participant  $1,250 per plan participant 
Preventive & Diagnostic Covered In Full Covered In Full
Basic Services (fillings, root canal, extractions, periodontal, endodontic) 50% Coinsurance Subject to Annual Maximum 60% Coinsurance Subject to Annual Maximum
Major Services (crowns, bridges, dentures) N/A 40% Coinsurance Subject to Annual Maximum
Orthodontia N/A N/A

*family=Employee plus any one or more additional family member(s)

 

Out-of-Network Coverage

Out-of-network service may be subject to a 'balance bill' for any amount that the dentist's charge exceeds SDC's allowable amount for an eligible service. The out-of-network reimbursement rate is 80%.

 

SDC Resources

Use www.superiordental.com or the SDC mobile app to:

  • view plan details
  • view and print your ID card
  • find a dentist

 

SDC Contact Information 
6683 Centerville Business Pkwy
Dayton, OH 45459
Phone: 937-438-0283 or Toll-Free 800-762-3159
Fax: 937-291-8695

 

Plan Information

Core Plan:

Group Number: A48730

Plan Number:1375

Benefit Summary

Enhanced Plan:

Group Number: A48730

Plan Number: 1619

Benefit Summary