Page 9 - Skyworks Solutions, Inc.

Health

Dental Plans

Regular visits to your dentist can protect more than Below is a summary of plan coverage based on
your smile; they help protect your overall health. the type of service. For more information, refer to
Skyworks offers two dental plans administered by Benefits Connection.
Delta Dental of Massachusetts.

Dental Dental Plus
1 1
In-network and Out-of-network In-network and Out-of-network
Deductible $50 Individual $50 Individual
$150 per Family $150 per Family
Calendar Year Maximum $1,750 (Types I-III) $3,000 (Types I-III)

Orthodontia Lifetime Maximum $1,750 $3,000

Benefit Coverage

Type I – Preventive & Diagnostic You Pay 0% (Deductible is Waived) You Pay 0% (Deductible is Waived)
Type II – Basic Services You Pay 20% You Pay 10%

Type III – Major Services You Pay 50% You Pay 40%
Type IV – Orthodontia You Pay 50% You Pay 50%
(adults & children)
Max Carry Over Feature

Benefit Threshold $700 $1,000

Carry Over Amount $500 $750

Maximum Carry Over $1,250 $1,500

Additional benefits in the Dental Plus include a third annual cleaning, white filling on the rear teeth
(Type II) and mouth guards for bruxism (Type III).

1 Non-participating dentists may balance bill. Subscribers are responsible for the difference between the non-participating maximum plan
allowance and the full fee charged by the dentist.

Skyworks Solutions Employee Benefits Guide - U.S. 9