Page 10 - 2025 US Neuro LLC - Benefit Guide

Dental Option:

Lincoln Financial Group

PAY PERIOD (26) HIGH Plan LOW Plan
Dependent Information
Employee Only $20.13 $13.06
Our company offers employees the opportunity to
Employee + Spouse $40.58 $32.48 cover their dependent children. Children can join
or remain on a parent’s dental plan until age 26.
Employee + Child(ren) $56.42 $46.02 When a child turns age 26, they will lose dental
coverage on the last day of their birth month.
Employee + Family $86.70 $67.83

BRIEF OVERVIEW Dental HIGH Plan Dental LOW Plan
Non-Network Dentists Non-Network Dentists
Type of Service Reimbursed at 90% of U&C Reimbursed at 90% of U&C

Annual Deductible (CYD) $50 Individual / $150 Family $50 Individual / $150 Family
Preventive Services Covered at 100%; CYD Waived Covered at 100%; CYD Waived

Basic Services Covered at 80% after CYD Covered at 80% after CYD
Major Services Covered at 50% after CYD Covered at 50% after CYD

$4,000 $2,000
Annual Maximum (January 1 to December 31) (January 1 to December 31)

Annual Maximum Preventive Services Does Not Apply Preventive Services Does Not Apply
*SmileRewards Included: *SmileRewards Included:
Smile Rewards (Included) Type 1 paid claims do not accumulate toward Type 1 paid claims do not accumulate to-
your Annual Maximum Benefit ward your Annual Maximum Benefit

Covered at 50% - CYD Waived Covered at 50% - CYD Waived
Orthodontia (Child Only)
Lifetime Maximum of $2,000 Lifetime Maximum of $1,500

Routine cleanings, exams, x-rays, oral can- Routine cleanings, exams, x-rays, oral
Preventive Services cer screenings. (Fluoride, sealants, space cancer screenings. (Fluoride, sealants,
maintainers under age 16) space maintainers under age 16)

Fillings (Amalgam or Composite), simple Fillings (Amalgam or Composite), simple
extractions, oral surgery, Endodontics extractions, oral surgery, Endodontics
Basic Services
(root canals), Periodontics. Emergency (root canals), Periodontics. Emergency
Treatment/General Services Treatment/General Services

Crowns, Implants (no missing tooth clause Crowns, Implants (no missing tooth
or waiting period), inlays, onlays, fixed clause or waiting period), inlays, onlays,
Major Services
partial denture (bridges) dentures & fixed partial denture (bridges) dentures
removable prosthetics & removable prosthetics

Orthodontic Exams, X-rays, Extractions, Study Orthodontic Exams, X-rays, Extractions,
Orthodontia
Models and Appliances; ADULTS & Children Study Models and Appliances; up to Age 19.

NOTE: This is only a brief overview. Please see the Benefit Summary for more details.
Members can obtain a listing of lens options at www.LFG.com. or Customer Service : 1-800-440-8453
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