J & L Ventures LLC - 2022 Benefit Guide

Dental Coverage

Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower. Your PPO dental plan is through Sun Life and offers “in and out-of-network” benefits.

Insurance Carrier:

Sun Life Dental Insurance

Plan Type:

PPO

Calendar Year Deductible Calendar Year Maximum

$50 / Individual; maximum of $150 family

$1,000

Preventive Services

100%

Basic Services Major Services

80% 50% 80%

Endo/Perio

Orthodontic Lifetime (dependent children only)

$1,000

Out-of-Network Reimbursement

90th Usual & Customary

Vision Coverage

The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them. Your PPO vision plan is through Sun Life and offers “in and out-of-network” benefits.

Insurance Carrier:

Sun Life Vision Insurance

Plan Type:

VSP Choice Plan

In-Network

Out-of-Network

Exam Services

$10 $25 $25 $25

$45 $30 $50 $60

Lenses - Single lined Lenses - Bifocal lined Lenses - Trifocal Contacts / Lenses

$ 130 allowance; then 20% off any remaining balance $130 allowance; then 20% off any remaining balance

Up to $105 Up to $70

Frames

Frequency for Exam / Lenses / Frames

12 months / 12 months / 24 months

15 J & L VENTURES, LLC 2022 BENEFIT GUIDE

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