Page 12 - 2018 Franke Enrollment
P. 12
Dental
Our dental plan makes dental care more affordable for employees and
their families. Taking care of your mouth, teeth, and gums is a big part
of making sure you feel your best. Healthy habits like brushing, lossing,
and seeing your dentist for regular cleanings help prevent problems.
Remember to choose an in-network dentist to ensure you’re receiving the
deepest level of discounted services.
Dental is administered by Cigna. You are encouraged to seek services
from Cigna dental PPO providers. Non-participating dentists will be
reimbursed at the 90th percentile of usual and customary and you may be
balance billed for the amount above Cigna’s reimbursement.
Core Plan High Plan
In-Network In-Network
Deductible/Maximum
Individual Deductible $50 $50
Family Deductible $150 $150
Calendar year maximum $1,250 $2,500
Coinsurance
Preventive Services 100% 100%
(Exams, x-rays, cleanings)
Basic Services 80% 80%
(Fillings, root canals, oral surgery)
Major Services 50% 50%
(Bridges, crowns, dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime Maximum $1,000 $2,500
Eligibility Adults and children
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Dental Bi-Weekly Contributions—Paid By You on a Pre-Tax
Basis
Coverage Tier Core Plan High Plan
Employee Only $4.95 $8.67
Employee + Spouse $18.63 $21.60
Employee + Child or Children $11.28 $17.88
Family $23.16 $31.99
12 2018 Benefits Enrollment
Our dental plan makes dental care more affordable for employees and
their families. Taking care of your mouth, teeth, and gums is a big part
of making sure you feel your best. Healthy habits like brushing, lossing,
and seeing your dentist for regular cleanings help prevent problems.
Remember to choose an in-network dentist to ensure you’re receiving the
deepest level of discounted services.
Dental is administered by Cigna. You are encouraged to seek services
from Cigna dental PPO providers. Non-participating dentists will be
reimbursed at the 90th percentile of usual and customary and you may be
balance billed for the amount above Cigna’s reimbursement.
Core Plan High Plan
In-Network In-Network
Deductible/Maximum
Individual Deductible $50 $50
Family Deductible $150 $150
Calendar year maximum $1,250 $2,500
Coinsurance
Preventive Services 100% 100%
(Exams, x-rays, cleanings)
Basic Services 80% 80%
(Fillings, root canals, oral surgery)
Major Services 50% 50%
(Bridges, crowns, dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime Maximum $1,000 $2,500
Eligibility Adults and children
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Dental Bi-Weekly Contributions—Paid By You on a Pre-Tax
Basis
Coverage Tier Core Plan High Plan
Employee Only $4.95 $8.67
Employee + Spouse $18.63 $21.60
Employee + Child or Children $11.28 $17.88
Family $23.16 $31.99
12 2018 Benefits Enrollment
