Page 10 - Enrollment Guide Example

2016 Benefits Enrollment

Dental

Dental Benefits

Access to good oral healthcare is important to your overall health. This is
why [Client Name] offers dental insurance as a core part of your beneits
package. You have the choice between two options under the [Carrier]

PPO plan. As with medical insurance, you will almost always pay less
if you visit an in-network dentist or specialist. To locate an in-network
provider, visit www.[Carrier].com.

Dental Beneits At-a-Glance
Low Option High Option
Eligibility Coverage begins on the irst day of the month, following
your date of hire
Deductible Single: $50 Single: $50
Family: $150 Family: $150
Annual maximum $1,000 $1,500
Lifetime orthodontia Not covered $1,000
maximum
Preventive care Covered at 100% Covered at 100%
Basic care Covered at 80%, after Covered at 90%, after
deductible deductible
Major care Covered at 50%, after Covered at 60%, after
deductible deductible
Orthodontia Not covered Covered at 50%, after
deductible

Please note: the low plan has lower monthly premiums,
but does not provide orthodontia coverage. The high
plan does provide orthodontia coverage for your

dependent children less than 19 years of age.

Dental
Low Plan High Plan
Bi-weekly Bi-weekly
Employee only $ $
Employee and spouse $ $
Employee and child(ren) $ $
Dental coverage is Employee and family $ $
provided by [Carrier].

10