KCA - 2018 Plan Year

DENTAL INSURANCE

Kisinger Campo & Associates offers dental coverage through Anchor Benefit Consulting, Inc. The Dental Plan allows you to see any provider and/or specialist you choose. The chart below provides a brief overview of the plan

Accepting Dentist: Patient presents ID card to dentist. The dentist can verify benefits via toll free number on ID card. At the time of visit, patient pays a $15.00 office visit co-payment and any applicable coinsurance. Dentist then files a claim for a balance.

Non-Accepting Dentist: Patient pays entire fee at time of visit or makes suitable arrangements with dentist’s office. Patient submits copay of bill and proof of payment with a claim form and patient is reimbursed for charges less a $20.00 copay and any applicable coinsurance.

DENTAL PLAN

In-Network

Calendar Year Deductible

NONE

Annual Maximum (per covered member)

Per covered member

$1,800

Tier 1

100% of the first $150

Tier 2

70% of the next $100

Tier 3

50% thereafter

Ortho

Lifetime Benefit

$1,800

Bi-Weekly Cost for Coverage

$14.59

Employee Only

$29.55

Employee + 1

$44.50

Employee + 2 or more

6

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