DENTAL COVERAGE
Reliance Matrix / Ameritas Contracted providers agree to bill Reliance Matrix directly and to accept a negotiated fee as payment in full. Allowable charges for out-of-network providers are paid based on the maximum reimbursable charge, as determined by Reliance Matrix. You may be responsible for any additional amounts (also called balance billing). To find a list of in-network providers, go to www.rsli.com/dental-vision and search for providers.
PPO Network Classic PPO Network (CA Only)
Out-of-Network
Annual Deductible Individual
$50 $150
Maximum per family
Preventive Care* (exams, x-rays, etc.)
Covered in full
Covered in full
Basic Services (fillings, extractions, etc.)
You pay 20%, deductible applies
You pay 20%, deductible applies
Major Services (crowns, bridges, dentures, etc.)
You pay 50% deductible applies
You pay 50%, deductible applies
Annual Maximum
$1,500 per person
Orthodontia
50% up to $1,000 Lifetime Maximum (Children Only)
11
TAYLOR METAL PRODUCTS // OPEN ENROLLMENT GUIDE // EFFECTIVE JANUARY 1, 2024
Made with FlippingBook - PDF hosting