Page 10 - Tacony 2021 Annual Benefits
P. 10
Dental Dental Coverage Provided by
Access to good oral healthcare can help keep your Anthem.
overall health costs down. Regular oral health exams Anthem Network Examples of
can help detect signiicant medical conditions before Covered Services
they become serious. Dental professionals performing Remember to visit Preventive—exams,
in-network dentists to
checkups can spot symptoms which could indicate receive the deepest level of cleanings, luoride,
serious health problems elsewhere in the body which discount on your services. x-rays, and sealants
need attention. For these reasons, and many others, we To ind a participating in- Basic—illings,
extractions,
offer two comprehensive dental plans through Anthem. network dentist in your area, periodontics, repairs,
go to anthem.com . and oral surgery
Important Dental Plan Note Major—crowns, inlays,
onlays, and dentures
When enrolling in dental coverage you have the choice
between the Standard Plan and the Buy-up Plan. The 2021 Associate Contributions
Buy-up Plan offers richer beneits than the Standard Weekly
Plan, but has higher premiums. Please note your dental Dental Standard Plan Buy-Up Plan
plan election is binding until the next plan year, which Associate Only $1 .41 $2 .23
means you will not be able to change dental plans Associate and Spouse $3 .28 $4 .97
again until the next annual enrollment period. If you Associate and Child(ren) $3 .64 $5 .53
experience a qualifying life event, you will be able to Associate and Family $5 .02 $7 .97
change your coverage tier, but you will not be able to
change dental plans.
Standard Plan Buy-Up Plan
In-Network Out-of-Network In-Network Out-of-Network
Calendar Year Deductible
Individual $50 $50 $50 $50
Family $150 $150 $150 $150
Calendar Year Maximum $1,000 $1,000 $1,500 $1,500
Coinsurance (plan pays)
Preventive 100% no deductible 100% no deductible
Basic 90% after deductible 80% after deductible 90% after deductible 80% after deductible
Major 60% after deductible 50% after deductible 60% after deductible 50% after deductible
Orthodontia
Coinsurance 50% no deductible 50% no deductible
Lifetime Maximum $1,000 $1,500
Beneit Applies To Children to age 19 Children and adults
This is a high-level summary of your beneit coverage. Full coverage details are available in your summary plan description (SPD). In the event there is a
discrepancy between what is relected in this guide and what is communicated in your SPD, the terms of your SPD will prevail.
10 2021 Benefits Enrollment
Access to good oral healthcare can help keep your Anthem.
overall health costs down. Regular oral health exams Anthem Network Examples of
can help detect signiicant medical conditions before Covered Services
they become serious. Dental professionals performing Remember to visit Preventive—exams,
in-network dentists to
checkups can spot symptoms which could indicate receive the deepest level of cleanings, luoride,
serious health problems elsewhere in the body which discount on your services. x-rays, and sealants
need attention. For these reasons, and many others, we To ind a participating in- Basic—illings,
extractions,
offer two comprehensive dental plans through Anthem. network dentist in your area, periodontics, repairs,
go to anthem.com . and oral surgery
Important Dental Plan Note Major—crowns, inlays,
onlays, and dentures
When enrolling in dental coverage you have the choice
between the Standard Plan and the Buy-up Plan. The 2021 Associate Contributions
Buy-up Plan offers richer beneits than the Standard Weekly
Plan, but has higher premiums. Please note your dental Dental Standard Plan Buy-Up Plan
plan election is binding until the next plan year, which Associate Only $1 .41 $2 .23
means you will not be able to change dental plans Associate and Spouse $3 .28 $4 .97
again until the next annual enrollment period. If you Associate and Child(ren) $3 .64 $5 .53
experience a qualifying life event, you will be able to Associate and Family $5 .02 $7 .97
change your coverage tier, but you will not be able to
change dental plans.
Standard Plan Buy-Up Plan
In-Network Out-of-Network In-Network Out-of-Network
Calendar Year Deductible
Individual $50 $50 $50 $50
Family $150 $150 $150 $150
Calendar Year Maximum $1,000 $1,000 $1,500 $1,500
Coinsurance (plan pays)
Preventive 100% no deductible 100% no deductible
Basic 90% after deductible 80% after deductible 90% after deductible 80% after deductible
Major 60% after deductible 50% after deductible 60% after deductible 50% after deductible
Orthodontia
Coinsurance 50% no deductible 50% no deductible
Lifetime Maximum $1,000 $1,500
Beneit Applies To Children to age 19 Children and adults
This is a high-level summary of your beneit coverage. Full coverage details are available in your summary plan description (SPD). In the event there is a
discrepancy between what is relected in this guide and what is communicated in your SPD, the terms of your SPD will prevail.
10 2021 Benefits Enrollment
