Page 13 - 2016 Benefit Booklet AYN

Page 13

Dental Benefits

Buy-Up Plan Provided by Ameritas

Type 1 Procedures: Diagnostic & Preventive
Services 100% covered
 Cleanings and exams-2 per benefit period No deductible
 X-rays (bitewings allowed twice per benefit
period)
 Fluoride for dependent children 18 & under
 Space Maintainers
 Sealants for dependent children 16 & under

Type 2 Procedures: Basic Services
 Full mouth X-rays-1 in 3 years 80% covered
 Simple extractions Deductible
 Denture Repair applies
 Endodontics
 Periodontics

Type 3 Procedures: Major Services
 Crowns 50% covered
 Complete Dentures Deductible
 Onlays applies
 Fixed Partial Dentures

Othodontia Services 50% covered
 $1,000 lifetime maximum
 Child Only Coverage