Page 12 - 2016 Benefit Booklet AYN

Page 12

Dental Benefits cont’d

 Employees contribute to the dental cost through payroll
deductions.
 Dependent children can be covered until the age of 26,
regardless of student status.
 Annual deductible of $50 per person, $150 per family, applies
to Basic & Major services.
 Annual benefit maximum is $1,500, combined from all service
types (diagnostic, preventive, basic and major).
 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 per pay period cost (pre-tax) for plan year 10/1/16
to 9/30/17

Employee Only $6.90
Emp + Spouse $22.98
Emp + Child(ren) $28.98
Emp + Family $48.37