Page 7 - 2018-19 APDerm Benefit Guide
P. 7
APDerm
DENTAL
Remember to visit in-network dentists to receive the deepest level of discount Bi-Weekly Dental
on your services. Contributions
To find a participating in-network dentist in your area go to unumdental.com
or call 888.222.2685. Employee Only $27.03
Employee and Spouse $53.67
Orthodontia Services Note Employee and $47.86
Child(ren)
The lifetime maximum illustrated is different from the calendar year Employee and Family $80.53
maximum. For orthodontia services, this limit does not reset each year, this
is the most your plan will cover for your services for the lifetime of your
participation in this program.
Examples of services
Preventive—exams, cleanings, fluoride, x-rays, and sealants
Basic—fillings, extractions, periodontics, and endodontics
Major—crowns, inlays, onlays, and dentures
We partner with Unum to offer you and your family members dental
insurance. Visit www.unumdental.com to find in-network providers and
access a variety of online tools and programs.
Dental Benefit Summary
(1)
In-Network Out-of-Network
Plan Year Deductible
Individual $50
Family $150
Plan Year Maximum
Per covered person $2,500
Coinsurance
Preventive 100% no deductible 100% no deductible
Basic 80% after deductible 80% after deductible
Major 50% after deductible 50% after deductible
(1) This is a high-level summary of your benefit coverage. Full coverage details
are available in your summary plan description (SPD). In the event there is a
discrepancy between what is reflected in this guide and what is communicated in
your SPD, the terms of your SPD will prevail.
7
DENTAL
Remember to visit in-network dentists to receive the deepest level of discount Bi-Weekly Dental
on your services. Contributions
To find a participating in-network dentist in your area go to unumdental.com
or call 888.222.2685. Employee Only $27.03
Employee and Spouse $53.67
Orthodontia Services Note Employee and $47.86
Child(ren)
The lifetime maximum illustrated is different from the calendar year Employee and Family $80.53
maximum. For orthodontia services, this limit does not reset each year, this
is the most your plan will cover for your services for the lifetime of your
participation in this program.
Examples of services
Preventive—exams, cleanings, fluoride, x-rays, and sealants
Basic—fillings, extractions, periodontics, and endodontics
Major—crowns, inlays, onlays, and dentures
We partner with Unum to offer you and your family members dental
insurance. Visit www.unumdental.com to find in-network providers and
access a variety of online tools and programs.
Dental Benefit Summary
(1)
In-Network Out-of-Network
Plan Year Deductible
Individual $50
Family $150
Plan Year Maximum
Per covered person $2,500
Coinsurance
Preventive 100% no deductible 100% no deductible
Basic 80% after deductible 80% after deductible
Major 50% after deductible 50% after deductible
(1) This is a high-level summary of your benefit coverage. Full coverage details
are available in your summary plan description (SPD). In the event there is a
discrepancy between what is reflected in this guide and what is communicated in
your SPD, the terms of your SPD will prevail.
7
