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 FOUR 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.
Base PPO Plan (unchanged from 2016)
Premium PPO Plan (unchanged from 2016)
In-Network
Deductible (applies to Basic & Major services)
$50
$50
Individual
$150
$150
Family
Annual Maximum (per covered member)
$1,000
$1,500
Preventive Services
Covered in full
Covered in full
Exams, Cleanings, & Fluoride
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
20% after deductible
20% after deductible
50% after deductible
50% after deductible
Orthodontia (child only)
40% $2,000 lifetime maximum per person
None
Out-of Network 1
90 th % Usual & Customary Charges
Basis of Payment
Deductible (applies to Basic & Major services)
$50 / $150
$50 / $150
Annual Maximum (per covered member)
$1,000
$1,500
Services Preventive
Covered in full 20% after deductible 50% after deductible
Covered in full 20% after deductible 50% after deductible
Basic Major
Orthodontia (child 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
$ 4.68 $12.13 $14.78 $24.51
$ 9.35 $21.56 $29.52 $45.26
EE
Employee + Spouse
ES
Employee + Child(ren)
EC
Employee + Family
FAM
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