Page 10 - 2018 CareHere Enrollment OOS

2018 Benefits Enrollment

Dental

Dental Benefits

We partner with BlueCross BlueShield of Tennessee to offer you and your
family members dental insurance. Visit www.bcst.com to ind in-network
providers and access a variety of online tools and programs.

Dental Beneits At-a-Glance
BCBST DentalBlue BCBST DentalBlue
Plan 1—Base Plan 2—With Orthodontia
In- and Out-of-Network* In- and Out-of-Network*
Deductible Single: $50 Single: $50
Family: 3 times individual Family: 3 times individual
Annual Maximum $1,500 $1,500
Preventive Care Covered at 100% Covered at 100%
Basic Care Covered at 80%, after Covered at 90%, after
deductible deductible
Major Care Covered at 50%, after Covered at 60%, after
Dental coverage deductible deductible
Orthodontia
is provided by Coinsurance
BlueCross BlueShield Not covered Covered at 50%, after
deductible
of Tennessee. Lifetime Maximum Not covered $1,500
Beneit Applies To N/A Children to age 19

* Services received from non-Preferred Dental Care providers are reimbursed at the maximum
allowable charge and you may be balance billed by the non-participating dentist.

Dental

Dental Option 2
Bi-Weekly Pre-Tax Contribution Dental Option 1 Child Orthodontia

Employee Only $14.63 $14.70
Employee + Spouse $34.64 $37.66
Employee + Child(ren) $28.33 $30.81
Family $51.64 $56.15

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