Page 7 - The Gori Law Firm 2020-21 Benefits Guide
P. 7
2020-2021
Enrollment Guide
DENTAL Finding In-Network
We partner with Aetna to offer you and your family Providers
members dental insurance. Visit www.Aetna.com to Remember to visit in-network dentists to receive the
access a variety of online tools and programs. deepest level of discount on your services.
In and Out-of-Network To ind an in-network provider, follow the below steps:
Calendar Year Deductible 1. Visit www.aetna.com
Individual $50 2. Choose “Find a Doctor”
Family $150
Calendar Year Maximum 3. Choose “Plan from an employer”
$1,500 4. Under “Continue as a Guest” enter your search
Coinsurance criteria, then click search
Preventive 100% no deductible 5. Towards the bottom of the “Select a Plan” section,
Basic 90% after deductible Choose Dental PPO/PDN with PPO II
Major 60% after deductible 6. Type in either a dentist name or just “Dentist” into
Orthodontia the “What do you want to search for near...” box
Coinsurance 50%
Lifetime Maximum $1,500 Examples of Services
Beneit Applies to Children up to age 19 Preventive—exams, cleanings, luoride, x-rays,
and sealants
Basic—illings, extractions, periodontics, repairs,
Balance Billing and oral surgery
Major—crowns, inlays, dentures, and bridges
Balance billing is when a provider bills you for the
diference between the providers charge and the
allowed amount. The allowed amount is the Orthodontia Services
maximum amount on which payment is based for The lifetime maximum illustrated is diferent from the
covered dental care services. However, a preferred calendar year maximum. For orthodontia services, this
provider, or in-network provider, may not balance bill limit does not reset each year, this is the most your
you. Seeing out-of-network providers opens you up to plan will cover for your services for the lifetime of your
being balance billed. participation in this program.
Employee Dental Cost Per Pay
Period
Employee Only $3.05
Employee and Spouse $5.85
Employee and Child(ren) $7.61
Family $10.93
7
Enrollment Guide
DENTAL Finding In-Network
We partner with Aetna to offer you and your family Providers
members dental insurance. Visit www.Aetna.com to Remember to visit in-network dentists to receive the
access a variety of online tools and programs. deepest level of discount on your services.
In and Out-of-Network To ind an in-network provider, follow the below steps:
Calendar Year Deductible 1. Visit www.aetna.com
Individual $50 2. Choose “Find a Doctor”
Family $150
Calendar Year Maximum 3. Choose “Plan from an employer”
$1,500 4. Under “Continue as a Guest” enter your search
Coinsurance criteria, then click search
Preventive 100% no deductible 5. Towards the bottom of the “Select a Plan” section,
Basic 90% after deductible Choose Dental PPO/PDN with PPO II
Major 60% after deductible 6. Type in either a dentist name or just “Dentist” into
Orthodontia the “What do you want to search for near...” box
Coinsurance 50%
Lifetime Maximum $1,500 Examples of Services
Beneit Applies to Children up to age 19 Preventive—exams, cleanings, luoride, x-rays,
and sealants
Basic—illings, extractions, periodontics, repairs,
Balance Billing and oral surgery
Major—crowns, inlays, dentures, and bridges
Balance billing is when a provider bills you for the
diference between the providers charge and the
allowed amount. The allowed amount is the Orthodontia Services
maximum amount on which payment is based for The lifetime maximum illustrated is diferent from the
covered dental care services. However, a preferred calendar year maximum. For orthodontia services, this
provider, or in-network provider, may not balance bill limit does not reset each year, this is the most your
you. Seeing out-of-network providers opens you up to plan will cover for your services for the lifetime of your
being balance billed. participation in this program.
Employee Dental Cost Per Pay
Period
Employee Only $3.05
Employee and Spouse $5.85
Employee and Child(ren) $7.61
Family $10.93
7
