Sun Life Indemnity PPO Dental plan provides you with a choice of any dentist or specialist you choose. By seeing a Sun Life Dental Network® dentist, you will receive discounts off their usual fees by approximately 30% which can save you money. To locate a participating dentist in your area, click PPO Dental on this page under Provider Search to complete the search. Claim forms must be filed, and certain limitations and exclusions apply. Coverage includes dental and vision benefits for one low cost, through payroll deduction. This plan is underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA).

This page includes a brief summary of the Indemnity PPO Dental plan benefits. A complete description of insured benefits, including limitations and exclusions, will be provided in the Certificate of Insurance.

PPO Provider search

Provider search allows dental plan members to easily locate participating network dentists and vision providers.

PPO dental

  • 4 periodontal cleanings per year
  • White fillings on back teeth
  • Brush biopsies for early cancer detection
  • Testing for genetic gum disease
  • Coverage for antimicrobial agents
  • Discounts on dental healthcare products

Type I preventive dental services, including:

  • routine oral exams
  • routine dental cleanings
  • fluoride treatment (children under 14)
  • sealants (children under 16)
  • space maintainers (children under 19)
  • minor treatment to control harmful habits
  • bitewing x-rays

Type II basic dental services, including:

  • x-rays:
    • complete series
    • panoramic
    • other x-rays (see certificate of insurance)
  • new fillings: replacement fillings
  • simple extractions, removal of exposed roots, incision and drainage
  • certain lab tests, pain treatment, therapeutic drug injections
  • endodontics (Root Canals)
  • endodontic treatment (Root Canal Treatment)

Type III major dental services, including:

  • complex oral surgery
  • minor gum disease treatment
    • provisional splinting, occlusal adjustments
    • scaling and root planing
    • periodontal maintenance
  • major gum disease treatment
    • gingivectomy, osseous surgery, other major periodontic procedures
  • initial placement, replacement and maintenance of inlays, onlays, crowns, fixed partial dentures (bridges), and partial and complete dentures

Type IV orthodontic dental services (only for dependent children under age 19)

  • limited orthodontic treatment
  • interceptive orthodontic treatment
  • comprehensive orthodontic treatment
  • harmful habit appliance (children under 16)
Payroll deduction Bi-Weekly Monthly
Employee $21.78 $43.55
Employee/Spouse $41.81 $83.61
Employee/Child(ren) $49.42 $98.83
Employee/Family $65.18 $130.35
  In-Network Coinsurance  Out-of-Network Coinsurance
Type 1 100% 100%
Type 2 80% 80%
Type 3 50% 50%
Calendar year maximum $2,000 $1,500
Calendar year deductible   $50 per person/$100 per family (applies to type 2 and 3 services only)
Type 4 50% 50%
Lifetime maximum $1,500 $1,500

2024 Certificate of Insurance

Resources

New hire and enrollment questions?

Call our agent State Securities Corp

Toll Free: 800-277-2300
Telephone: 850-386-2300

Existing plan member questions?

PPO: 800-442-7742
Prepaid: 800-443-2995

To submit a claim, mail to:

Sun Life
PO Box 1618
Milwaukee, WI 53201-1618

Email questions or comments to:
claims.dental@sunlife.com

As a member, you have access to view your plan information, claim status and more through your Sun Life account (previously named Online Advantage). Register and/or log in today to access your benefits online!

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As a member, you have access to a wide range of information about dental health care and how it relates to your general health and preventive wellness.

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Did you know that more than 75% of American adults suffer from various forms of gum disease and don’t even know it?

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To enroll for your dental plan, please call People First at 866-663-4735 or enroll online.

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Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 15-GP-01 and 16-DEN-C-01. Prepaid dental products are provided by Sun Life Assurance Company of Canada (SLOC) (Wellesley Hills, MA), under Form Series BDC-GDSA.

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© 2022 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. The Sun Life name and logo are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.

SLPC 29218 09/22 (exp. 09/24)