Page 8 - 2018 Roquette Benefit Guide
P. 8
Balance billing is the practice of non- Dental
network dentists billing the patient for
amounts which exceed the maximum Your oral health is a critical component of your overall health. Roquette
reimbursement under a patient’s partners with Wellmark to provide a comprehensive dental plan.
dental plan. The patient is responsible
for the additional amounts charged. To access a list of participating providers visit www.wellmark.com.
The following chart summarizes the key features of the plan.
Core Plan Benefits
In-Network Out-of-Network
Deductible $25 per person, maximum of 3 per family
Individual Beneit Maximum Per $1,500 per person
Year
Preventative Beneits (Routine 100% 100%
Exams, X-rays, etc.)
Basic Services (illings, general 100% 100%
anesthesia, etc.)
Major Services (extractions, 50% 50%
crowns, surgery, etc.)
Orthodontia 50% 50%
Orthodontia Lifetime Maximum $2,000 per child (children under 19 only)
Dental Premium
Monthly
Employee Only $21.30
Employee & Spouse $42.90
Employee & Child(ren) $38.60
Family $64.00
8 2018 Benefits Enrollment
network dentists billing the patient for
amounts which exceed the maximum Your oral health is a critical component of your overall health. Roquette
reimbursement under a patient’s partners with Wellmark to provide a comprehensive dental plan.
dental plan. The patient is responsible
for the additional amounts charged. To access a list of participating providers visit www.wellmark.com.
The following chart summarizes the key features of the plan.
Core Plan Benefits
In-Network Out-of-Network
Deductible $25 per person, maximum of 3 per family
Individual Beneit Maximum Per $1,500 per person
Year
Preventative Beneits (Routine 100% 100%
Exams, X-rays, etc.)
Basic Services (illings, general 100% 100%
anesthesia, etc.)
Major Services (extractions, 50% 50%
crowns, surgery, etc.)
Orthodontia 50% 50%
Orthodontia Lifetime Maximum $2,000 per child (children under 19 only)
Dental Premium
Monthly
Employee Only $21.30
Employee & Spouse $42.90
Employee & Child(ren) $38.60
Family $64.00
8 2018 Benefits Enrollment
