DENTAL INSURANCE
MicroLumen offers dental coverage through Sun Life. The Dental PPO Plan allows you to use in-network or out-of- network benefits. If out-of-network dentists are used, you will be responsible for pay the difference between Sun Life’s allowed amount and what the dentist may charge, also known as “balance billing”.
The chart below provides a brief overview of the plan.
To find a network provider go to www.sunlife.com/findadentist and select the Assurant Dental Network. Once you have enrolled you can register your account on www.sunlife.com/onlineadvantage to search providers and view claims.
Dental PPO Plan
Out-of Network 1
In-Network
Calendar Year Deductible Individual
$50
$50
$150
$150
Family
Annual Maximum
Per covered member
$1,500 $1,500
Preventive Services
Covered in full
Covered in full
Exams, Cleanings, & Fluoride
Basic Services
Fillings, Simple Extractions, & Periodontal Maintenance
0% after deductible
20% after deductible
Major Services
Crowns, Bridges, Perio, Endo, Surgical Extractions, Root Canal, & Dentures
40% after deductible
50% after deductible
Orthodontia
Child only
50% $1,000 lifetime maximum per person
50% $1,000 lifetime maximum per person
Basis of Payment
Contracted Rate
Maximum Allowable Amount
1 Subject to balance billing. Please refer to your plan document for specific details.
Employee Cost (Semi-Monthly)
Employee Only
$10.95 $24.77 $24.78 $39.49
Employee + Spouse
Employee + Child(ren)
Family
4
Made with FlippingBook - Online catalogs