Page 5 - ARCO Construction 2015 Benefits Guide

2015 Associate Benefits

Dental Insurance

Coverage is provided through Delta Dental. Below is a summary of beneits
offered under the plan.

Delta Dental PPO Premier/Out-of-
Network
Calendar Year Deductible (waived for Preventive)
Individual $50 $50
Family $150 $150
Calendar Year Maximum Delta Dental will be issuing new ID
$1,000 $1,000 cards. The cards will arrive at your
Coinsurance home prior to the effective date
Preventive 100% 100% of December 1, 2014.
Basic 90% 80%
Major 60% 50%
Orthodontia
Deductible None None
Coinsurance 50% 50%
Lifetime Maximum $1,000 $1,000
Beneit applies to Child(ren) under 19 Child(ren) under 19
Visits & Exams
Visit for Oral examination 100% 100%
Prophylaxis, including scaling 100% 100%
& polishing
Fluoride 100% 100%
Sealants 90% 80%
X-rays
Bitewing X-rays 100% 100%
Full mouth X-rays 100% 100%
Endodontics
90% 80%
Minor Restorations
Amalgam (silver) illings 90% 80%
Composite illings (anterior 90% 80%
teeth only)
Periodontics
Incision and drainage of 90% 80%
abscess
Uncomplicated extractions 90% 80%
Prosthodontics/Major Restorations
Crowns 60% 50%
Full & partial dentures 60% 50%

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