Page 14 - 2016 Benefit Booklet AYN

Page 14

Dental Benefits cont’d

 Employees contribute to the dental cost through payroll
deductions.
 There is a 12 month waiting period for orthodontia coverage
for new enrollees only.
 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 $2,000, 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 $13.52
Emp + Spouse $35.75
Emp + Child(ren) $44.25
Emp + Family $71.68