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DENTAL PLAN
TheBANK offers eligible full-time, exempt, and oficer employees along
with their dependents, dental coverage through a self-funded plan. Our
dental administrator is UMR and we utilize the Connection network.
When possible, we encourage you to utilize an in-network dentist. Using
an in-network dentist ensures you are receiving a discount on dental
services, and also avoiding any balance billing potential. To search for in-
network providers, visit umr.com or call 800.826.9781.
Premium Plan Basic Plan
Calendar Year Deductible
Individual $50 $100
Family $150 $300
Calendar Year Maximum
$1,500 $1,000
Coinsurance Preventive Services (cleanings, x-ray, luoride, sealants)
100%, no deductible 100%, no deductible
Restorative Services (illings, endodontics, periodontics)
80% after deductible 70% after deductible
Major Services (crowns, bridges, dentures)
50% after deductible 50% after deductible
Orthodontia
Coinsurance 50% Not covered
Lifetime Maximum $1,000 Not covered
Applies to dependent
children under age 19 only
Important note: if you and/or your dependents apply for coverage as a late enrollee (after
your initial new hire period), covered beneits during the irst 12 months of coverage include
accidental dental injuries, preventive and diagnostic services, and basic services . Covered
persons will be eligible for major services following 12 months of coverage under this plan .
7/1/19 to 12/31/19 Dental Plans
B-Weekly Premium
Premium Basic
Employee Only $4 .90 $3 .30
Employee + Spouse $20 .56 $13 .86
Employee + Child(ren) $13 .22 $9 .52
Employee + Family $28 .20 $21 .12
12 2019 Benefits Enrollment
TheBANK offers eligible full-time, exempt, and oficer employees along
with their dependents, dental coverage through a self-funded plan. Our
dental administrator is UMR and we utilize the Connection network.
When possible, we encourage you to utilize an in-network dentist. Using
an in-network dentist ensures you are receiving a discount on dental
services, and also avoiding any balance billing potential. To search for in-
network providers, visit umr.com or call 800.826.9781.
Premium Plan Basic Plan
Calendar Year Deductible
Individual $50 $100
Family $150 $300
Calendar Year Maximum
$1,500 $1,000
Coinsurance Preventive Services (cleanings, x-ray, luoride, sealants)
100%, no deductible 100%, no deductible
Restorative Services (illings, endodontics, periodontics)
80% after deductible 70% after deductible
Major Services (crowns, bridges, dentures)
50% after deductible 50% after deductible
Orthodontia
Coinsurance 50% Not covered
Lifetime Maximum $1,000 Not covered
Applies to dependent
children under age 19 only
Important note: if you and/or your dependents apply for coverage as a late enrollee (after
your initial new hire period), covered beneits during the irst 12 months of coverage include
accidental dental injuries, preventive and diagnostic services, and basic services . Covered
persons will be eligible for major services following 12 months of coverage under this plan .
7/1/19 to 12/31/19 Dental Plans
B-Weekly Premium
Premium Basic
Employee Only $4 .90 $3 .30
Employee + Spouse $20 .56 $13 .86
Employee + Child(ren) $13 .22 $9 .52
Employee + Family $28 .20 $21 .12
12 2019 Benefits Enrollment
