Dental
DEX Imaging offers 2 dental plan options through Sunlife Financial. The PPO Dental plans allow you to use in‐network or out‐of‐network benefits. If out‐of‐network dentists are used, you will be responsible for paying the difference between Sunlife’s allowed amount and what the dentist may charge, also known as “balance billing”. The chart below provides a brief overview of the plans.
LOW PPO Dental Plan
HIGH PPO Dental Plan
IN‐NETWORK CALENDAR YEAR DEDUCTIBLE (applies to basic and major services only) Individual $50
$50
$150
$150
Family
ANNUAL MAXIMUM (maximum Sunlife will pay towards claims per year) Per covered person $1,250
$1,250
DIAGNOSTIC & PREVENTIVE
Exams, Cleanings (2 in 12 months), X‐Rays, Sealants, etc.
Covered in full
Covered in full
BASIC SERVICES
Amalgam Fillings, Extractions ‐ Single Tooth, Endodontics (Root Canal) & Periodontics (Gum Disease)
20% after deductible
Covered in full after deductible
MAJOR SERVICES Crowns, Bridges & Dentures OUT‐OF‐NETWORK* CALENDAR YEAR DEDUCTIBLE
50% after deductible
40% after deductible
$100 / $300
$100 / $300
ANNUAL MAXIMUM
$1,250
$1,250
SERVICES Diagnostic & Preventive Basic Major
You pay 0% after deductible 50% after deductible 75% after deductible
You pay 0% after deductible 20% after deductible 50% after deductible
Cost for coverage (per paycheck)
Employee
$ 8.74 $20.48 $22.01 $33.19
$13.27 $31.12 $33.43 $50.42
Employee + Spouse Employee + Child(ren) Employee + Family
6 • Subject to balance billing. Please refer to your plan document for specific details.
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