Page 34 - 2020 Benefit
P. 34
A Guide to Your Health and Wellness Benefits | 2020
Voluntary Dental Coverage
Regular dental exams can help you and your dentist detect problems in the early stages when treatment is
simpler and costs are lower. Keeping your teeth and gums clean and healthy will help prevent most tooth
decay and periodontal disease and is an important part of maintaining your medical health.
The Company offers you a choice of two dental plans the DHMO and the DPPO. New this year is the
addition of orthodontia coverage to the DPPO for children (up to age 19). Dental Plans are offered through
Aetna.
Plan Provision DHMO DPPO
In-Network In-Network Out-of-Network
Annual deductible (Individual/family) None $50 / $150 $50 / $150
Annual maximum per person Unlimited $1,500 $1,500
Diagnostic and preventive care: Includes cleanings,
No copay 100% 100%
fluoride treatments, and x-rays
Basic services: Includes fillings, periodontics, scaling Various copays–see
80%* 80%*
and root planning, and oral surgery dental care schedule
Major services: Includes crowns, bridges and full and Various copays-see
50%* 50%*
partial dentures dental care schedule
50% 50%
Orthodontia (Child/Adult) $1,945 Children Only Children Only
$1,500 Lifetime Max $1,500 Lifetime Max
*After deductible is met
Voluntary Vision Coverage
The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them.
The vision plan is offered through Aetna.
Benefit In-Network Out-of-Network
Exam $10 copay $25 Reimbursement
Frequency
Every 12 months
Exam
Lenses Every 12 months
Frames Every 24 months
Frames $130 allowance
$65 Reimbursement
20% off balance over allowance
Lenses
Single vision lenses $10 copay $20 Reimbursement
Bifocal lenses $10 copay $40 Reimbursement
Trifocal lenses $10 copay $65 Reimbursement
Medically necessary contact lenses $0 copay; paid in full $200 Reimbursement
Elective contact lenses in lieu of glasses $115 allowance
$80 Reimbursement
15% off balance over allowance
5 | 2020 Benefit Guide
