Page 9 - Dent Wizard 2018 New Hire Guide 0123.18

Dental Coverage
Administered by Aetna
The Schedule Plan pays a fixed amount for covered services after you meet a $50 deductible. You will pay the difference if the bill is more than Aetna paid. Annual limit each calendar year: $1,000
The Comprehensive Plan pays 100% for preventive care such as cleanings or x-rays and pays
60% – 80% of most covered services after
the $50 deductible is met. Annual limit each calendar year: $1,500
Both plans covers 50% orthodontia up to a $1,500 lifetime limit.
DENTAL PLANS
Benefit
Schedule (Basic) Dental Plan
Comprehensive Dental Plan
Annual Deductible
$50 per person / $150 per family
$50 per person / $150 per family
Annual Max Benefit
$1,000 per person
$1,500 per person
Orthodontia Lifetime Maximum
$1,500 per person
$1,500 per person
Preventive Services
(includes exams and cleanings)
Fixed fee, no deductible
Covered at 100% of R&C charges, no deductible
Basic & Major Services
(includes fillings and extractions)
Fixed fee, after deductible
80% of R&C charges, after deductible
Prosthodontic Services
(includes crowns and dentures)
Fixed fee, after deductible
60% of R&C charges, after deductible
Orthodontic Service
50% of R&C charges, no deductible up to a $1,500 lifetime limit
50% of R&C charges, no deductible up to a $1,500 lifetime limit
DENTAL PLANS MONTHLY RATES
Monthly Premium Comparison
Basic
Comprehensive
Employee
$1.74
$26.38
Employee + 1
$4.34
$51.81
Family
$7.57
$80.85
Dent Wizard | 2018 Benefits Guide 9