Dental
Detwiler’s Farm Market offers 2 dental plan options through Sunlife Financial. The PPO Dental plans allow you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between Sunlife’s allowed amount and what the dentist may charge, also known as “balance billing” . The chart below provides a brief overview of the plans.
LOW PPO Dental Plan
HIGH PPO Dental Plan
IN-NETWORK
CALENDAR YEAR DEDUCTIBLE (applies to basic and major services only)
$50
$50
Individual
$150
$150
Family
ANNUAL MAXIMUM (maximum Sunlife will pay towards claims per year)
Per covered person
$1,250
$1,250
DIAGNOSTIC & PREVENTIVE
Exams, Cleanings (2 in 12 months), X-Rays, Sealants, etc.
Covered in full
Covered in full
BASIC SERVICES
Amalgam Fillings, Extractions - Single Tooth, Endodontics (Root Canal) & Periodontics (Gum Disease)
20% after deductible
Covered in full after deductible
MAJOR SERVICES
50% after deductible
40% after deductible
Crowns, Bridges & Dentures
OUT-OF-NETWORK* CALENDAR YEAR DEDUCTIBLE
$100 / $300
$100 / $300
ANNUAL MAXIMUM
$1,250
$1,250
SERVICES Diagnostic & Preventive Basic Major
You pay 0% after deductible 50% after deductible 75% after deductible
You pay 0% after deductible 20% after deductible 50% after deductible
Cost for coverage (per paycheck)
Employee
$ 8.74
$13.27
Employee + Spouse Employee + Child(ren) Employee + Family
$20.48 $22.01 $33.19
$31.12 $33.43 $50.42
• Subject to balance billing. Please refer to your plan document for specific details.
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