Page 10 - 2019 Heico Core Benefits Guide
P. 10
2019 | The Heico Companies Enrollment Guide
Dental Plan
BCBSIL
Heico offers dental insurance through Blue Cross Blue Shield 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� Benefits are based on negotiated fees, and participating dentists
have agreed to accept negotiated fees�
PPO Plan Design In-Network Out-of-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 80% 80%***
(restorative, general, endodontic, periodontic and oral surgery)
Major Services 50% 50%***
(crowns, inlays, onlays, prosthodontic, implants)
Orthodontia (Plan pays)** 50% 50%***
Orthodontist Lifetime Maximum (per eligible member) $1,500
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
2019 Employee Dental Contributions
Monthly DID YOU
Employee $22 KNOW?!
Employee + 1 $40
Family $50
You are entitled to two
To view covered services, status of a claim, deductible balance, oral health, and cleanings per calendar year
wellness information, go to www. bcbsil. com/ member �
and they don’t have to be six
months apart.
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Dental Plan
BCBSIL
Heico offers dental insurance through Blue Cross Blue Shield 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� Benefits are based on negotiated fees, and participating dentists
have agreed to accept negotiated fees�
PPO Plan Design In-Network Out-of-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 80% 80%***
(restorative, general, endodontic, periodontic and oral surgery)
Major Services 50% 50%***
(crowns, inlays, onlays, prosthodontic, implants)
Orthodontia (Plan pays)** 50% 50%***
Orthodontist Lifetime Maximum (per eligible member) $1,500
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
2019 Employee Dental Contributions
Monthly DID YOU
Employee $22 KNOW?!
Employee + 1 $40
Family $50
You are entitled to two
To view covered services, status of a claim, deductible balance, oral health, and cleanings per calendar year
wellness information, go to www. bcbsil. com/ member �
and they don’t have to be six
months apart.
10
