Page 10 - Guide
P. 10
2017 BENEFITS ENROLLMENT
Dental Insurance
Regional One Health offers 2 dental plan options for you and your family through BlueCross BlueShield of
Tennessee. You may visit any BlueCross BlueShield dental provider. You must meet an annual deductible before
the plan pays a percentage of expenses which are reasonable and customary.
Dental Benefit Summary
Regional One Health
BlueCross BlueShield BlueCross BlueShield
Option 1 Option 2
Dental Blue Dental Blue
Dentemax Network Dentemax Network
In Network Out-of-Network In Network Out-of-Network
Calendar Year Deductible
Individual $50 $50 $50 $50
Family $150 $150 $150 $150
Calendar Year Maximum
$1,000 $1,000 $1,500 $1,500
Coinsurance
Preventive 100% no deductible 100% no deductible 100% no deductible 100% no deductible
Basic 80% after deductible 80% after deductible 80% after deductible 80% after deductible
Major 10% after deductible 10% after deductible 50% after deductible 50% after deductible
Orthodontia
Deductible N/A N/A Same as above Same as above
Coinsurance N/A N/A 50% after deductible 50% after deductible
Lifetime Maximum N/A N/A $1,500 $1,500
Beneit Applies To N/A N/A Children Children
Endodontics
80% after deductible 80% after deductible 80% after deductible 80% after deductible
Periodontics
80% after deductible 80% after deductible 80% after deductible 80% after deductible
Bi-Weekly Premium Comparison
Regional One Health Regional One Health
Option 1 Option 2
Employee Only $11 .54 $18 .31
Employee + Spouse $20 .30 $33 .35
Employee + Child(ren) $19 .56 $32 .51
Family $28 .33 $46 .73
Additional coverage information is available to you at http://visityouville.com/ROHBeneits.
10 REGIONAL ONE HEALTH
Dental Insurance
Regional One Health offers 2 dental plan options for you and your family through BlueCross BlueShield of
Tennessee. You may visit any BlueCross BlueShield dental provider. You must meet an annual deductible before
the plan pays a percentage of expenses which are reasonable and customary.
Dental Benefit Summary
Regional One Health
BlueCross BlueShield BlueCross BlueShield
Option 1 Option 2
Dental Blue Dental Blue
Dentemax Network Dentemax Network
In Network Out-of-Network In Network Out-of-Network
Calendar Year Deductible
Individual $50 $50 $50 $50
Family $150 $150 $150 $150
Calendar Year Maximum
$1,000 $1,000 $1,500 $1,500
Coinsurance
Preventive 100% no deductible 100% no deductible 100% no deductible 100% no deductible
Basic 80% after deductible 80% after deductible 80% after deductible 80% after deductible
Major 10% after deductible 10% after deductible 50% after deductible 50% after deductible
Orthodontia
Deductible N/A N/A Same as above Same as above
Coinsurance N/A N/A 50% after deductible 50% after deductible
Lifetime Maximum N/A N/A $1,500 $1,500
Beneit Applies To N/A N/A Children Children
Endodontics
80% after deductible 80% after deductible 80% after deductible 80% after deductible
Periodontics
80% after deductible 80% after deductible 80% after deductible 80% after deductible
Bi-Weekly Premium Comparison
Regional One Health Regional One Health
Option 1 Option 2
Employee Only $11 .54 $18 .31
Employee + Spouse $20 .30 $33 .35
Employee + Child(ren) $19 .56 $32 .51
Family $28 .33 $46 .73
Additional coverage information is available to you at http://visityouville.com/ROHBeneits.
10 REGIONAL ONE HEALTH
