Page 7 - 2016 Enrollment
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Zydus Pharmaceuticals (USA) Inc.
Dental
Dental Coverage
In 2016, your dental coverage will be provided by Aetna, which
offers an expansive network of dental providers across the country.
We encourage you to visit www.aetna.com and search its provider
directory to verify your current dentist is participating in Aetna’s
preferred dental network.
If not, you can locate other nearby network providers so your
family gets the best value for any needed dental services. Remember,
services provided by out-of-network providers may subject you and
your family to balance-billings for any expenses which exceed what is
deemed reasonable and customary.
Dental Coinsurance
Beneits Services Deductible (Plan Pays) Beneit Maximum
Class I Exams, cleanings, x-rays, sealants, No deductible 100% (in- and out-of-network) $1,500 calendar
emergency treatment year maximum per
Class II Minor restorative—illings, gum $50 individual/$150 80% (in- and out-of-network) person
disease, root canals, extractions, family, per calendar
oral surgery year
Class III Major restorative—crowns, bridges, 50% (in- and out-of-network)
dentures, implants
Class IV Orthodontics—braces (children up No deductible 50% (in- and out-of-network) $1,500 lifetime
to age 26; must be banded by age maximum per
20) eligible dependent
Your 2016 semi-monthly contributions are shown below.
Aetna Dental PPO Plan
Employee only $2.00
Employee + 1 $3.63
Family $6.25
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Dental
Dental Coverage
In 2016, your dental coverage will be provided by Aetna, which
offers an expansive network of dental providers across the country.
We encourage you to visit www.aetna.com and search its provider
directory to verify your current dentist is participating in Aetna’s
preferred dental network.
If not, you can locate other nearby network providers so your
family gets the best value for any needed dental services. Remember,
services provided by out-of-network providers may subject you and
your family to balance-billings for any expenses which exceed what is
deemed reasonable and customary.
Dental Coinsurance
Beneits Services Deductible (Plan Pays) Beneit Maximum
Class I Exams, cleanings, x-rays, sealants, No deductible 100% (in- and out-of-network) $1,500 calendar
emergency treatment year maximum per
Class II Minor restorative—illings, gum $50 individual/$150 80% (in- and out-of-network) person
disease, root canals, extractions, family, per calendar
oral surgery year
Class III Major restorative—crowns, bridges, 50% (in- and out-of-network)
dentures, implants
Class IV Orthodontics—braces (children up No deductible 50% (in- and out-of-network) $1,500 lifetime
to age 26; must be banded by age maximum per
20) eligible dependent
Your 2016 semi-monthly contributions are shown below.
Aetna Dental PPO Plan
Employee only $2.00
Employee + 1 $3.63
Family $6.25
7
