Page 11 - Allegacy 2017 booklet 8.5x11

Allegacy Benefit Solutions Page 11

Dental Benefits cont’d

 This benefit is 100% paid by the employee through payroll deductions.
 Dependent children can be covered until the age of 26, regardless
of student status.
 Newborns should be added no later than the age of 2, in order to
keep from being coded as a late entrant
 Annual deductible of $50 per person, $150 per family, applies to Type
2 & 3 services.
 Annual benefit maximum is $1,250, combined from all service types.
 This is an indemnity plan, therefore members are able to see any
dental provider regardless of network. This plan reimburses at the
90th UCR.

Employees monthly cost for plan year 1/1/17 to 12/31/17:
Employee Only $8.62 Emp + Spouse $37.32
Emp + Child(ren) $37.42 Family $46.14