Acom - 2024 Benefits Guide - Class 3 - All Eligible Employe…

Dental Coverage

Good dental care is critical to your overall well-being. With Sun Life Dental Insurance, you can get the attention your teeth need - at a cost you can afford. To get the most from your benefits and reduce out-of-pocket costs, choose an in-network provider by utilizing our large national network. These providers have agreed to file your claims and uphold the highest quality standards.

Insurance Carrier:

Sun Life Dental Insurance

Plan Type:

Basic

Enhanced

Calendar Year Deductible Calendar Year Maximum

$50 Individual / $150 Family $50 Individual / $150 Family

$1,000

$2,000

Preventive Services

100%

100%

Basic Services Major Services

80% 50%

90% 60%

Orthodontia (dependent children only) Out-of-Network Reimbursement

N / A

$1,000

90th UCR

90th UCR

Employee Weekly Deduction Employee Only

$3.38 $7.90 $7.77

$6.90

Employee + Spouse Employee + Child(ren)

$13.28 $18.59 $23.51

Family

$11.14

time insured continuously under a dental plan benefits provided for only these services Less than 6 months Preventive Services At least 6 months but less than 12 months Preventive Services and fillings under Basic Services At least 12 months Preventive, Basic, Major and Ortho Services

9 ACOM INTEGRATED SOLUTIONS 2024 BENEFITS GUIDE

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