Page 34 - RTF.24 Employee Benefits

2018 Dental Benefits

Dental Care Plus
HMO Dental Plan

You have the option to enroll in our group dental plan. The benefits and your contributions are as
follows:

You are strongly encourage to use an in Benefit In Network
network dentist is order to maximize Annual Deductible $50 / $150
your benefits and minimize your out-of- Individual/Family
pocket cost. To see if your dentist is in (waived for Preventive and
the network click on Provider Network Diagnostic services)
and select the DMHO network. Annual Maximum $1,000
Preventive Services Covered at 100%
•
Oral Exams
• Cleanings
Payment to Non Network providers will • X-Rays
be based on the Network fee schedule, • Fluoride Treatment
and could result in balance billing. (through age 18)
Basic Services Include Covered 80% after deductible
• Fillings
Emergency Visits
•
Dental Care Plus Customer Service • Simple Denture Repair
800-367-9466 or 513-554-1100 • Basic Oral Surgery
• Simple Extractions
• Endodontic
• Periodontic
• Sealants
Major Services Include: Covered 50% after deductible
• Complex Extractions
• Crowns
• Inlays, Onlays
• Bridgework
• Complex / Partial Denture
Orthodontic Services Covered 50%
Limited to eligible dependents $1000 individual lifetime maximum
under 19 years if age

Coverage Election Weekly
Employee Only $3.21
Employee + Spouse $6.40
Employee + Children $6.72
Family $12.41

For additional plan information, please refer to the detailed plan description provided by the carrier.
In the event of a discrepancy, the carrier Pan Document shall prevail.