Page 19 - 2016 Enrollment
P. 19
American Food & Vending
Dental Coverage
Special Benefit: if a member
Dental submits at least one claim
Our dental plan makes dental care more affordable for employees and stays under $500 a part
of the unused maximum
and their families. Research suggests the health of your mouth will be rolled over for use in
mirrors the overall health of your body. That’s why we offer dental future years
coverage through our insurance partner Guardian. With this coverage
you’ll have broad access to in-network providers. With an expansive
selection of in-network providers you have a better chance of
avoiding additional out-of-pocket exposure or “balance billing”.
Balance billing is the practice of non-network providers billing the
patient for amounts exceeding the reimbursement amount under your
Guardian dental plan. When this happens, you are responsible for the
additional amounts charged. Make sure your dentist is in Guardian’s
Network at www.guardianlife.com. Stay in-network and ensure your
savings!
Dental In-network Out-of-network
Annual Deductible
Individual $50
Family limit 3 per family 3 per family
Waived for Preventive Preventive
Charges Covered for You (Coinsurance)
Preventative care (e.g., cleanings) 100% 100%
Basic care (e.g., illings) 80% 80%
Major care (e.g., crowns, dentures) 50% 50%
Orthodontia Not covered Not covered
Annual maximum beneits $1,000
Dependent Age Limits To age 26 To age 26
This summary of beneits is intended to be a brief outline of coverage. The entire
provisions of beneits and exclusions are contained in the Summary Plan Description (SPD).
In the event of a conlict between the SPD and this description, the terms of the SPD will
prevail.
Weekly Contribution Rates
Employee $5.35
Employee + spouse $11.24
Employee + child(ren) $9.63
Family $17.13
19
Dental Coverage
Special Benefit: if a member
Dental submits at least one claim
Our dental plan makes dental care more affordable for employees and stays under $500 a part
of the unused maximum
and their families. Research suggests the health of your mouth will be rolled over for use in
mirrors the overall health of your body. That’s why we offer dental future years
coverage through our insurance partner Guardian. With this coverage
you’ll have broad access to in-network providers. With an expansive
selection of in-network providers you have a better chance of
avoiding additional out-of-pocket exposure or “balance billing”.
Balance billing is the practice of non-network providers billing the
patient for amounts exceeding the reimbursement amount under your
Guardian dental plan. When this happens, you are responsible for the
additional amounts charged. Make sure your dentist is in Guardian’s
Network at www.guardianlife.com. Stay in-network and ensure your
savings!
Dental In-network Out-of-network
Annual Deductible
Individual $50
Family limit 3 per family 3 per family
Waived for Preventive Preventive
Charges Covered for You (Coinsurance)
Preventative care (e.g., cleanings) 100% 100%
Basic care (e.g., illings) 80% 80%
Major care (e.g., crowns, dentures) 50% 50%
Orthodontia Not covered Not covered
Annual maximum beneits $1,000
Dependent Age Limits To age 26 To age 26
This summary of beneits is intended to be a brief outline of coverage. The entire
provisions of beneits and exclusions are contained in the Summary Plan Description (SPD).
In the event of a conlict between the SPD and this description, the terms of the SPD will
prevail.
Weekly Contribution Rates
Employee $5.35
Employee + spouse $11.24
Employee + child(ren) $9.63
Family $17.13
19
