Page 11 - Dentons 2021 Benefits Guide Hawaii
P. 11
2021
Dentons Benefits Guide
DENTAL PLAN
HDS PPO Dental Plan
Partners and Principals All Other Employees
Monthly Premiums Monthly Premiums
Single $40.01 $20.00
Single + 1 $80.00 $40.00
Family $120.01 $60.00
HDS Dental Plan
In-Network Coverage Out-of-Network Coverage
Calendar Year Maximum
$1,500 per family member $500 per family member
Type A Services: Preventive Care
100% 70%
Cleanings and oral examinations
Type B Services: Basic Care
70%
Fillings
Type C Services: Major Care
50%
11
Dentons Benefits Guide
DENTAL PLAN
HDS PPO Dental Plan
Partners and Principals All Other Employees
Monthly Premiums Monthly Premiums
Single $40.01 $20.00
Single + 1 $80.00 $40.00
Family $120.01 $60.00
HDS Dental Plan
In-Network Coverage Out-of-Network Coverage
Calendar Year Maximum
$1,500 per family member $500 per family member
Type A Services: Preventive Care
100% 70%
Cleanings and oral examinations
Type B Services: Basic Care
70%
Fillings
Type C Services: Major Care
50%
11
