Page 13 - 2019 Franke Enrollment Guide
P. 13
Franke
DENTAL
Our dental plan makes dental care more affordable for employees and their
families. Taking care of your mouth, teeth, and gums is a big part of making
sure you feel your best. Healthy habits like brushing, flossing, and seeing your
dentist for regular cleanings help prevent problems. Remember to choose an
in-network dentist to ensure you’re receiving the deepest level of discounted
services.
Dental is administered by Cigna. You are encouraged to seek services from
Cigna dental PPO providers. You have the choice of Cigna DPPO Advantage
and Cigna DPPO providers for in-network services. Non-participating
dentists will be reimbursed at the 90th percentile of usual and customary and
you may be balance billed for the amount above Cigna’s reimbursement.
Core Plan High Plan
In-Network In-Network
Deductible/Maximum
Individual Deductible $50 $50
Family Deductible $150 $150
Calendar year maximum $1,250 $2,500
Coinsurance
Preventive Services 100% 100%
(Exams, x-rays, cleanings)
Basic Services 80% 80%
(Fillings, root canals, oral surgery)
Major Services 50% 50%
(Bridges, crowns, dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime Maximum $1,000 $2,500
Eligibility Adults and children
Please refer to your Summary Plan Description (SPD) for complete details of plan
benefits, limitations, and exclusions. In the event of a conflict between the SPD and
this description, the terms of the SPD will prevail.
Dental Bi-Weekly Contributions—Paid By You
on a Pre-Tax Basis
Coverage Tier Core Plan High Plan
Employee Only $4.95 $8.67
Employee + Spouse $18.63 $21.60
Employee + Child or Children $11.28 $17.88
Family $23.16 $31.99
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DENTAL
Our dental plan makes dental care more affordable for employees and their
families. Taking care of your mouth, teeth, and gums is a big part of making
sure you feel your best. Healthy habits like brushing, flossing, and seeing your
dentist for regular cleanings help prevent problems. Remember to choose an
in-network dentist to ensure you’re receiving the deepest level of discounted
services.
Dental is administered by Cigna. You are encouraged to seek services from
Cigna dental PPO providers. You have the choice of Cigna DPPO Advantage
and Cigna DPPO providers for in-network services. Non-participating
dentists will be reimbursed at the 90th percentile of usual and customary and
you may be balance billed for the amount above Cigna’s reimbursement.
Core Plan High Plan
In-Network In-Network
Deductible/Maximum
Individual Deductible $50 $50
Family Deductible $150 $150
Calendar year maximum $1,250 $2,500
Coinsurance
Preventive Services 100% 100%
(Exams, x-rays, cleanings)
Basic Services 80% 80%
(Fillings, root canals, oral surgery)
Major Services 50% 50%
(Bridges, crowns, dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime Maximum $1,000 $2,500
Eligibility Adults and children
Please refer to your Summary Plan Description (SPD) for complete details of plan
benefits, limitations, and exclusions. In the event of a conflict between the SPD and
this description, the terms of the SPD will prevail.
Dental Bi-Weekly Contributions—Paid By You
on a Pre-Tax Basis
Coverage Tier Core Plan High Plan
Employee Only $4.95 $8.67
Employee + Spouse $18.63 $21.60
Employee + Child or Children $11.28 $17.88
Family $23.16 $31.99
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