~Dual Comp Staff Provider Onboarding Binder 06.26.20

DENTAL INSURANCE

DENTAL PLAN INFORMATION

65%+ FTE FACULTY 75%+ FTE STAFF

ELIGIBILITY

PLAN INFORMATION

BASIC

BASIC ORTHO

HIGH

HIGH ORTHO

$50 PER PERSON $150 FAMILY APPLIES TO ALL SERVICES, EXCEPT DIAGNOSTIC AND PREVENTIVE $500 PER PERSON, EXCLUDING ORTHODONTIC SERVICES

$25 PER PERSON $75 FAMILY APPLIES TO ALL SERVICES, EXCEPT DIAGNOSTIC AND PREVENTIVE

$50 PER PERSON $150 FAMILY APPLIES TO ALL SERVICES, EXCEPT DIAGNOSTIC AND PREVENTIVE $2,000 PER PERSON, EXCLUDING ORTHODONTIC SERVICES

$50 PER PERSON $150 FAMILY APPLIES TO ALL SERVICES

ANNUAL DEDUCTIBLE

$500 PER PERSON

$1,000 PER PERSON

ANNUAL MAXIMUM BENEFIT

80% AFTER DEDUCTIBLE

100% NO DEDUCTIBLE

100% NO DEDUCTIBLE

100% NO DEDUCTIBLE

PREVENTIVE CARE

80% AFTER DEDUCTIBLE

80% AFTER DEDUCTIBLE

80% AFTER DEDUCTIBLE

80% AFTER DEDUCTIBLE

BASIC RESTORATIVE SERVICES

60% AFTER DEDUCTIBLE

80% AFTER DEDUCTIBLE

60% AFTER DEDUCTIBLE

60% AFTER DEDUCTIBLE

MAJOR SERVICES

50% AFTER DEDUCTIBLE

60% AFTER DEDUCTIBLE

NOT COVERED

NOT COVERED

ORTHODONTIC SERVICES

($1,000 LIFETIME MAX PER PERSON)

($2,000 LIFETIME MAX PER PERSON)

EMPLOYEE CONTRIBUTION

RATES VARY BASED ON COVERAGE SELECTION https://www.uc.edu/hr/benefits/employee-contributions.html (CHOOSE 2020 Non-AAUP)

PLAN ADMINISTRATOR

ANTHEM

EXCLUSIONS AND LIMITATIONS : ALL PLANS ARE SUBJECT TO EXCLUSIONS, LIMITATIONS AND PERIODIC UPDATES. ORTHODONTICS ARE FOR DEPENDENT CHILDREN ONLY UNDER AGE 19. FOR DETAILS ABOUT THE PLANS, CONTACT ANTHEM CUSTOMER SERVICE AT 1-877-604-2156

Additional Insurance 2

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