Page 18 - Apricity Benefits Guide
P. 18
2020
Apricity Benefits Overview
DENTAL BENEFITS
Good dental health is important to your overall well-being. At
the same time, we all need different levels of dental treatment.
It is for this reason that eligible employees are offered the
choice of two dental plans through Delta Dental.
DeltaCare USA HMO Plan
The DeltaCare USA HMO Plan offers participants the following
features:
Covered procedures have predetermined copays (i.e., set
dollar amounts) when provided by in-network dentists. This
means out-of-pocket costs are predictable.
Nearly 300 procedures are covered.
No copays or low copays for most diagnostic and
preventive services.
No annual deductibles and no maximums for covered
beneits.
No exclusion for pre-existing dental conditions or missing
teeth.
If you choose to enroll in this plan, you will be asked to verify
that you have reviewed the network prior to enrolling to
ensure that you have access to a provider in your area.
For Arizona, Florida, Georgia, Illinois, Kansas, Missouri, New
York, New Jersey, Ohio, South Carolina, Tennessee, and Texas:
DeltaCare USA is a prepaid plan that features set copays for
covered beneits. When you enroll, you choose from many
conveniently located DeltaCare USA contracted general
dentists to receive beneits under your plan. If you do not
select a dentist, Delta Dental will select a dentist for you. Your
DeltaCare USA dentist will coordinate authorization for referrals
for specialty care treatment for you.
No claim forms are required.
You only need to pay the speciied copay for covered
services provided at the time of your visit.
There is an out-of-area emergency care allowance.
Table of Contents Your Quick Guide to Savings and Group Auto and Home Insurance .33
About Your Beneits Program. . . . . . .2 Spending Accounts .............16 Group Legal Services ............33
Beneits Basics ...................3 Dental Beneits .................18 Employee Assistance Program ....34
Medical/Prescription Drugs Beneits . 6 Dental Plan Summary ............20 Medicare Part D Creditable
Comparing Medical Plan Options ..7 Vision Beneits ..................21 Coverage Notice ...............35
First Stop Health ................11 Voluntary Disability Insurance .....22 Premium Assistance Under Medicaid
Medical Plan Summary ..........12 Life and AD&D Insurance ........25 and the Children’s Health Insurance
Program (CHIP) .................42
Pharmacy Plan Summary .........13 Voluntary Accident Insurance ....29 Contact Information .............46 18
Flexible Spending Accounts ......14 Voluntary Critical Illness Insurance . 31
Apricity Benefits Overview
DENTAL BENEFITS
Good dental health is important to your overall well-being. At
the same time, we all need different levels of dental treatment.
It is for this reason that eligible employees are offered the
choice of two dental plans through Delta Dental.
DeltaCare USA HMO Plan
The DeltaCare USA HMO Plan offers participants the following
features:
Covered procedures have predetermined copays (i.e., set
dollar amounts) when provided by in-network dentists. This
means out-of-pocket costs are predictable.
Nearly 300 procedures are covered.
No copays or low copays for most diagnostic and
preventive services.
No annual deductibles and no maximums for covered
beneits.
No exclusion for pre-existing dental conditions or missing
teeth.
If you choose to enroll in this plan, you will be asked to verify
that you have reviewed the network prior to enrolling to
ensure that you have access to a provider in your area.
For Arizona, Florida, Georgia, Illinois, Kansas, Missouri, New
York, New Jersey, Ohio, South Carolina, Tennessee, and Texas:
DeltaCare USA is a prepaid plan that features set copays for
covered beneits. When you enroll, you choose from many
conveniently located DeltaCare USA contracted general
dentists to receive beneits under your plan. If you do not
select a dentist, Delta Dental will select a dentist for you. Your
DeltaCare USA dentist will coordinate authorization for referrals
for specialty care treatment for you.
No claim forms are required.
You only need to pay the speciied copay for covered
services provided at the time of your visit.
There is an out-of-area emergency care allowance.
Table of Contents Your Quick Guide to Savings and Group Auto and Home Insurance .33
About Your Beneits Program. . . . . . .2 Spending Accounts .............16 Group Legal Services ............33
Beneits Basics ...................3 Dental Beneits .................18 Employee Assistance Program ....34
Medical/Prescription Drugs Beneits . 6 Dental Plan Summary ............20 Medicare Part D Creditable
Comparing Medical Plan Options ..7 Vision Beneits ..................21 Coverage Notice ...............35
First Stop Health ................11 Voluntary Disability Insurance .....22 Premium Assistance Under Medicaid
Medical Plan Summary ..........12 Life and AD&D Insurance ........25 and the Children’s Health Insurance
Program (CHIP) .................42
Pharmacy Plan Summary .........13 Voluntary Accident Insurance ....29 Contact Information .............46 18
Flexible Spending Accounts ......14 Voluntary Critical Illness Insurance . 31
