Page 9 - 2019-2020 Country Financial Credit Union Benefit Booklet

Voluntary Dental Plan Summary

Country Financial Credit Union offers voluntary dental insurance through Sun Life
Financial. You can visit any licensed dentist for services; however, you could see lower
out-of-pockets costs when you visit a dentist in the PPO Network.

Additional plan features:
 Your plan includes our Lifetime of Smiles® program, with benefits many people
prefer, such as brush biopsies for the early detection of oral cancer
 Your plan includes Preventive Max Waiver® which allows covered dental
expenses for preventive service to not apply to the annual maximum
 Sun Life Dental Network®, the PPO network for your plan, includes 125,000+ unique dentists, offers you more
options to help save on fees and can make your annual maximum go even further7you get exclusive access to

Dependent children can remain on the dental up to age 26.
Please refer to the Benefit Summary for limitations and exclusions.

Sun Life Financial
Group #: 934875
(800) 442-7742 / www.sunlife.com/findadentist

Type I Preventive Dental Services Covered 100%

Type II Basic Dental Services Covered 80%

Type III Major Dental Services Covered 50%

Type IV Orthodontic Services Covered 50%

$50 Individual / $150 Family
Calendar Year Deductible
(applies to Basic and Major Services only)

Calendar Year Maximum $1,500 per person per Plan Year
(applies to Basic and Major Services only)

Orthodontia Lifetime Maximum $1,000 lifetime per child under age 26

Employee Bi-Weekly Pre-Tax Contributions

Employee Only $ 14.71
Employee + Spouse $ 33.29
Employee + Child(ren) $ 30.57
Employee + Family $51.45
It is recommended that all treatment plans exceeding $300

be submitted to Sun Life for pre-determination of benefits.

Note: This is intended to be an easy-to-read summary (not a contract); the above items are only highlights of the plans. Additional limitations and exclusions
may apply to covered services. For a full description of your coverage, please refer to your Certificate of Coverage. In the event of any inconsistencies with
the comparison and the insurer’s Certificate of Coverage, the Certificate will control.

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