Dental Plans Highlights
Eligibility
First day of the month after 30 days of employment. Full-time staff only (minimum of 30 hours a week).
Plan Highlights
PPOLOW
PPOHIGH
In-Network
Out-of-Network*
In-Network
Out-of-Network*
Annual Individual Deductible
$0
$300
$50
$50
Annual Family Deductible
$0
$900
$150
$150
Preventative Care
100% Coinsurance
50% Coinsurance after deductible
100% Coinsurance no deductible 80% Coinsurance after deductible 50% Coinsurance after deductible
100% Coinsurance no deductible 80% Coinsurance after deductible 50% Coinsurance after deductible
30% Coinsurance after deductible
Basic Procedures
80% Coinsurance
Major Procedures
40% Coinsurance
25% Coinsurance after deductible
Calendar Year Max Benefit
$1,000 per person
$2,000 per person
Orthodontia
N/A
N/A
$1,500 lifetime maximum for dependents up to age 19
* Additional employee payment responsibility known as ‘Balance Billing’ applies to all out of network services
Employee Contributions
PPOLOWPRE-TAXCOSTS
PPOHIGHPRE-TAXCOSTS
Monthly Cost
Per Pay Period
Monthly Cost
Per Pay Period
Employee
$16.25
$45.36
$7.50
$20.94
Employee + Spouse
$31.95
$83.75
$14.75
$38.65
Employee + Child(ren)
$45.06
$121.81
$20.80
$56.22
Family
$60.90
$169.35
$28.11
$78.16
33
Made with FlippingBook - professional solution for displaying marketing and sales documents online