Page 27 - Skechers 2022 Benefits Guide
P. 27
HAWAII KAISER DENTAL PLAN
OVERVIEW — HAWAII ONLY
HAWAII DENTAL SERVICE (HDS) – HAWAII ONLY
You automatically receive the Hawaii Kaiser dental plan when electing the Hawaii Kaiser medical plan. In Kaiser’s dental plan, all care is provided by Hawaii Dental Services (except in an emergency), or the plan will not pay benefits. Selecting a Primary Care Dentist (PCD) is required. To find a Primary Care Dentist near you, please visit deltadentalhi.org or by calling 808-529-9248.
HAWAII KAISER VISION PLAN
OVERVIEW — HAWAII ONLY
KAISER VISION BENEFITS – HAWAII ONLY
You automatically receive the Hawaii Kaiser vision plan when electing the Hawaii Kaiser medical plan. In the Kaiser Vision Plan, all of your care must be received within the Kaiser network (except in an emergency) or the plan will not pay benefits. To find participating providers near you, please visit the Kaiser website at kp.org or call 808-432-5955.
KAISER DENTAL PLAN
Services
Diagnostic and Preventive—annual exam, basic cleanings, diagnostic x-rays
Basic Restorative—restorative, endodontics, periodontics, simple extractions
No Charge
Services
Vision Exam
Frames and Lenses OR Contact Lenses (for children only)
No Copay
Allowance of $150 (every calendar year) for children 19 years and younger.
ANY LICENSED PROVIDER
KAISER VISION PLAN
ANY LICENSED PROVIDER
Your Cost Share Shown Below
Your Cost Share Shown Below
30% Major Services—crowns, dentures 50%
KAISER CONTRIBUTIONS PAGE 26
Contributions include medical, dental and vision.
2022 BENEFITS 27
