DENTAL INSURANCE
AMIkids offers dental coverage through Blue Cross Blue Shield (BCBS). Both plan options are Dental PPOs, which allow you to use in- network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for the balance billed amount (the difference between BCBS’ allowed amount and what the dentist charges). AMIkids has not raised Dental Plan premiums for FIVE years! The chart below provides a brief overview of the plans. To find in-network providers visit www.MyHealthToolkitFL.com and click on “Find a Dentist” within the right column. If the below illustration of benefits conflicts in any way with the plan description, then the plan description shall prevail.
Base PPO Plan (unchanged from 2017)
Premium PPO Plan (unchanged from 2017)
In-Network
Deductible (applies to Basic & Major services) Individual
$50
$50
$150
$150
Family
Annual Maximum (per covered member)
$1,000
$1,500
Preventive Services Exams, Cleanings, & Fluoride
Covered in full
Covered in full
Basic Services Fillings, Simple Extractions, Perio & Endo (other than those listed below) Major Services Crowns, Bridges, Surgical Extractions, Root Canal, Dentures, Osseus Surgery & Endo Molars Orthodontia (child 18 and under only)
20% after deductible
20% after deductible
50% after deductible
50% after deductible
40% $2,000 lifetime maximum per person
None
Out-of Network 1
Basis of Payment
90% Usual & Customary Charges
Deductible (applies to Basic & Major services) Individual / Family Annual Maximum (per covered member)
$50 / $150
$50 / $150
$1,000
$1,500
Services Preventive Basic Major
Covered in full 20% after deductible 50% after deductible
Covered in full 20% after deductible 50% after deductible
Orthodontia (child 18 and under only)
40% $2,000 lifetime maximum per person
None
1 Subject to balance billing . Please refer to your plan document for specific details.
Cost for Coverage Amounts shown are per pay check ( 24 payments/year ) Base PPO
Premium PPO
Employee Only
EE ES EC
$ 4.68 $12.13 $14.78 $24.51
$ 9.35 $21.56 $29.52 $45.26
Employee + Spouse Employee + Child(ren) Employee + Family
FAM
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