Page 9 - 2015 BRP Benefits Guide
P. 9
2015 Annual Enrollment
Dental
Dental
Our dental plans make dental care more affordable for employees and their Bi-Weekly Dental Coverage
families. Taking care of your mouth, teeth, and gums is a big part of making Cost
sure you feel your best. Healthy habits like brushing, lossing, and seeing Basic Premium
your dentist for regular cleanings help prevent problems. Remember to Plan Plan
choose an in-network dentist to ensure you’re receiving the deepest level of Employee $4.26 $6.54
discounted services. Employee + $8.54 $13.08
Spouse
Employee + $8.54 $13.08
There are no changes to your dental plan design in 2015. Dental coverage Child
will continue to be offered through UHC. Please review the additional Employee + $14.48 $22.18
details provided regarding the plan design and cost of dental insurance Children $17.17 $26.30
Family
through BRP. Keep in mind, the information in the chart provided is a
summary only.
In-Network Out-of-Network
Basic Premium Basic Premium
Plan Plan Plan Plan
Deductible/Maximum
Individual Deductible $25 $25
Family Deductible $75 $75
Calendar Year Maximum $1,500 $3,000 $1,500 $3,000
Coinsurance
Preventive Services (Exams, 100% 100%
x-rays, cleanings)
Basic Services 80% 80%
(illings, root canals, oral surgery)
Major Services 80% 80%
(Bridges, Crowns, Dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime Maximum $3,000 $3,000
Eligibility Children and adults
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Only if you are changing your dental plan should you expect new dental cards.
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Dental
Dental
Our dental plans make dental care more affordable for employees and their Bi-Weekly Dental Coverage
families. Taking care of your mouth, teeth, and gums is a big part of making Cost
sure you feel your best. Healthy habits like brushing, lossing, and seeing Basic Premium
your dentist for regular cleanings help prevent problems. Remember to Plan Plan
choose an in-network dentist to ensure you’re receiving the deepest level of Employee $4.26 $6.54
discounted services. Employee + $8.54 $13.08
Spouse
Employee + $8.54 $13.08
There are no changes to your dental plan design in 2015. Dental coverage Child
will continue to be offered through UHC. Please review the additional Employee + $14.48 $22.18
details provided regarding the plan design and cost of dental insurance Children $17.17 $26.30
Family
through BRP. Keep in mind, the information in the chart provided is a
summary only.
In-Network Out-of-Network
Basic Premium Basic Premium
Plan Plan Plan Plan
Deductible/Maximum
Individual Deductible $25 $25
Family Deductible $75 $75
Calendar Year Maximum $1,500 $3,000 $1,500 $3,000
Coinsurance
Preventive Services (Exams, 100% 100%
x-rays, cleanings)
Basic Services 80% 80%
(illings, root canals, oral surgery)
Major Services 80% 80%
(Bridges, Crowns, Dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime Maximum $3,000 $3,000
Eligibility Children and adults
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Only if you are changing your dental plan should you expect new dental cards.
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