Policyholder: JESSINC Group voluntary dental insurance
Benefit Summary for all eligible employees Effective date: 07/01/202 3
What's available to me? Dental insurance helps pay for all, or a portion, of the costs associated with dental care, from routine cleanings to root canals.
Eligibility Eligible employees
All active, full-time employees Calendar-year deductible
Coinsurance your policy pays
In-network
Out-of-network
In-network
Out-of-network
$0
$0
100%
100%
Preventive
$50 $50
$50 $50
80% 50%
80% 50%
Basic Major
Additional provisions Family deductible
2 times the per person deductible amount Combined deductible Your deductibles that are in and out-of-network for basic and major services are combined. Combined maximum Maximums for preventive, basic, and major procedures are combined. In-network calendar year maximums are $1,000 per person or non-networkcalendar year maximums are $1,000 per person. Maximum accumulation Included Plantype Scheduled Who can buy coverage? • You may buy coverage if you're an active, full-time employee. Seasonal, temporary, or contract employees can't purchase. o If you’re on regularly scheduled day off, holiday, vacation day, jury duty, funeral leave, or personal time off, you’re still considered actively at work, as long as you’re fulfilling your regular duties and were working the day immediately prior to your time off. o You must enroll within 31 days of being eligible. If you don’t, you’ll have to wait until the next open enrollment period, or qualifying event. Additional eligibility requirements may apply.
Which procedures are covered, and how often? Preventive Routine exams Twice per calendar year
Insurance issued by Principal Life Insurance Company, 711 High Street, Des Moines, IA 50392 04052210597 - 6 Page 1 of 4
Made with FlippingBook flipbook maker