Page 10 - Frank Bailey Grain 2021-2021 Benefit Guide

Dental Option:
Humana

Dependent Information

Frank Bailey Grain, Co. offers employees the
opportunity to cover their dependent children.
Children can join or remain on a parent’s dental plan
Rate Per Pay Period until age 26. When a child turns 26, they will lose
dental coverage on the last day of their birth month.
Coverage Tier Weekly Monthly Weekly Monthly
Core Plan Core Plan Buy Up Plan Buy Up Plan
Employee Only $ 5.03 $21.79 $12.95 $ 56.11

Employee + Spouse $11.39 $49.34 $25.90 $112.22

Employee + Child(ren) $13.36 $57.90 $33.02 $143.08

Employee + Family $21.04 $91.18 $45.97 $199.19

Type of Service Core Plan Buy Up Plan

Preventive Services Covered at 100% No Deductible Covered at 100%; No Deductible

Basic Services Covered at 80% after CYD Covered at 80% after CYD

Not Covered—See Benefit Summary
Major Services Covered at 50% after CYD
for more details
Calendar Year Deductible $50 Individual / $150 Family $50 Individual / $150 Family

Annual Maximum $1,000 Unlimited

Type of Service Benefit Description Benefit Description

Oral Exams, Cleanings, X-rays, Oral Exams, Cleanings, X-rays,
Preventive Services
Sealants, Fluoride Treatment Sealants, Fluoride Treatment
Amalgam and Composite Fillings,
Amalgam and Composite Fillings, Oral
Basic Services Oral Surgery, Endodontics,
Surgery
Periodontics
Crowns, Bridges, Dentures, Implants, Crowns, Bridges, Dentures,
Major Services
Periodontics and Endodontics Inlays & Onlays and Implants
NOTE: This is only a brief overview. Please see Benefit Summary more details.

Website: www.humana.com or Customer Service : 877-877-1051

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