Maximum Benefits
There are limits on the benefits you can receive from the Expatriate Dental Plan. The maximum benefit is $2,000 per person per year for preventive and restorative care. The lifetime maximum benefit for orthodontia is $2,500 per child. Please Note: The maximums reflect a combined amount for in- and out-of-network care.
If you were previously enrolled in a U.S. domestic Dental Plan, the benefits you received under that plan will be added to benefits you receive under the Expatriate Dental Plan for purposes of determining benefits provided under the lifetime orthodontia maximum. Any benefits that have been applied to a maximum provision under a U.S. domestic dental plan of your heritage organization will also be applied to the lifetime maximums for the Expatriate Dental Plan.
The most you can ever receive in orthodontia benefits under the Expatriate Dental Plan for each eligible child under age 19 is the lifetime maximum benefit of $2,500. This limit includes benefits paid under a U.S. domestic Dental Plan and dental plans of your heritage organization and under the Traditional Indemnity, a former U.S. domestic Dental Plan. If you transfer to a U.S. domestic Dental Plan, or vice versa, you do not gain a new lifetime orthodontia maximum. Any benefits paid under one dental plan will apply against the others.
For example, assume you've received $2,000 in orthodontia benefits for one child under the Expatriate Dental Plan. Then, upon repatriation/transfer to the U.S., you elect coverage under the U.S. domestic PDP Dental Plan. The most the PDP Plan will pay toward that child's orthodontia expenses is the difference between what was paid under the Expatriate Dental Plan ($2,000) and the PDP's lifetime orthodontia maximum — $2,500 for in-network expenses and $2,000 for out-of-network expenses.
In this case, if care is received in-network, the most the PDP Plan will pay for that child's orthodontia expenses is $500 ($2,500 - $2,000 = $500). However, the PDP would not pay anything more for care received out-of-network for that child, since the PDP Plan's lifetime orthodontia maximum has already been met under the Expatriate Dental Plan.