Page 10 - Letterpress 2020 Benefit Guide_Revised 9-25-2020
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Dental Option:
Dental Select
2020 Rate Per Pay Period Dependent Information
Employee Only $ 15.38 Letterpress Graphics, Inc. offers employees the
opportunity to cover their dependent children.
Employee + Spouse $ 37.30 Children can join or remain on a parent’s dental plan
until age 26.
Employee + Child(ren) $ 40.54
When a child turns 26, they will lose dental coverage
Employee + Family $ 59.66 on the last day of their birth month.
(In-Network) Amount Paid
Type of Service
Out of Network is Paid @ 90% of R&C
Preventive Services Covered at 100%; No Deductible
Basic Services Covered at 80% after Calendar Year Deductible
Major Services Covered at 50% after Calendar Year Deductible
Discount Vision Benefit through (EyeMed) Cost vary by services. Must see In-Network Providers
Calendar Year Deductible $50 Individual / $150 Family
Annual Maximum $1,500 per person
Waiting Periods New Hires or Open Enrollment NONE
Type of Service Benefit Description
Routine Exams, Cleanings (2 per year), X-rays, Fluoride
Preventive Services
Treatment
Amalgam and Composite Fillings, Simple Extractions, Space
Basic Services Maintainers, Oral Surgery, General Anesthesia, Endodontics,
Periodontics
Crowns, Bridges, Dentures, Inlays & Onlays and Implants
Major Services
Alternate
Annual Maximum Applies January 1 to December 31
NOTE: This is only a brief overview. Please see Benefit Summary more details.
Website: www.dentalselect.com or Customer Service : 800-999-9789
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