Page 10 - 2020 HEICO Enrollment
P. 10
DENTAL PLAN
Did You Know?
You are entitled to two cleanings BCBSIL
per calendar year and they don’t
have to be six months apart . Heico offers dental insurance through BlueCross BlueShield of Illinois.
The Preferred Provider Organization (PPO) dental program provides
eligible employees with easy access to a national network of dental
providers, consisting of general, and specialty dentists who meet well-
established credentialing standards. Beneits are based on negotiated fees,
and participating dentists have agreed to accept negotiated fees.
Out-of-
PPO Plan Design In-Network Network
Deductible
Individual $50 $50
Family $150 $150
Calendar Year Maximum $1,500
Coinsurance (Plan Pays)
Preventive Services* 100% 100%***
(exams, X-rays and cleanings)
Basic Services
(restorative, general, endodontic, periodontic and 80% 80%***
oral surgery)
Major Services 50% 50%***
(crowns, inlays, onlays, prosthodontic, implants)
Orthodontia (Plan pays)** 50% 50%***
Orthodontist Lifetime Maximum $1,500
(per eligible member)
Exam/Cleaning Frequency Two every calendar year
* Not subject to deductible
** Provided for employees, their spouse, and dependent children up to age 19
*** Usual and customary charge
2020 Employee Dental Contributions
Monthly
Employee $23
Employee + 1 $42
Family $52
To view covered services, status of a claim, deductible balance, oral
health, and wellness information, go to www. bcbsil. com/ member.
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Did You Know?
You are entitled to two cleanings BCBSIL
per calendar year and they don’t
have to be six months apart . Heico offers dental insurance through BlueCross BlueShield of Illinois.
The Preferred Provider Organization (PPO) dental program provides
eligible employees with easy access to a national network of dental
providers, consisting of general, and specialty dentists who meet well-
established credentialing standards. Beneits are based on negotiated fees,
and participating dentists have agreed to accept negotiated fees.
Out-of-
PPO Plan Design In-Network Network
Deductible
Individual $50 $50
Family $150 $150
Calendar Year Maximum $1,500
Coinsurance (Plan Pays)
Preventive Services* 100% 100%***
(exams, X-rays and cleanings)
Basic Services
(restorative, general, endodontic, periodontic and 80% 80%***
oral surgery)
Major Services 50% 50%***
(crowns, inlays, onlays, prosthodontic, implants)
Orthodontia (Plan pays)** 50% 50%***
Orthodontist Lifetime Maximum $1,500
(per eligible member)
Exam/Cleaning Frequency Two every calendar year
* Not subject to deductible
** Provided for employees, their spouse, and dependent children up to age 19
*** Usual and customary charge
2020 Employee Dental Contributions
Monthly
Employee $23
Employee + 1 $42
Family $52
To view covered services, status of a claim, deductible balance, oral
health, and wellness information, go to www. bcbsil. com/ member.
10
