Page 5 - TNJH 2019 Benefits Guide
P. 5

Dental Coverage


        Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are
        lower. Keeping your teeth and gums clean and healthy will help prevent most tooth decay and periodontal disease, and is an
        important part of maintaining your medical health.
        TNJH offers two dental insurance plans through Cigna.  The chart below is a brief outline of each plan.  Please refer to the
        summary plan  description for complete plan details.

                                                          DPPO Buy-Up Plan*                      DHMO Plan**
         Plan Provision
                                                 In-Network             Out-of-Network            In-Network
         Deductible
         (Individual/Family)                       $0/$0                  $50/$150                   N/A

         Calendar Year Maximum                     $1,500                  $1,500                    N/A

         Diagnostic and Preventive Care: Includes    Plan pays 100%, no deductible   Plan pays 100%, no deductible   Most services provided at no
         exams, cleanings, sealants and x-rays                                                      charge

         Basic Services: Includes fillings, denture                   Plan pays 80% , after   Member copay according to
                                          Plan pays 90% , no deductible
         repair, extractions, root canal therapy                          deductible            charge schedule

         Major Services: Includes crowns, inlays,   Plan pays 60% , no deductible   Plan pays 60% , after   Member copay according to
         onlays, bridges, dentures                                        deductible            charge schedule


                                            Plan pays 60% , no ortho   Plan pays 60% , no ortho   Member copay according to
         Orthodontia
                                                 deductible               deductible            charge schedule
         Orthodontia Lifetime Maximum              $1,500                  $1,500                    None


          *Dental rates for DPPO plan have increased due to rising plan costs.
          ** DHMO Plan is provided at no cost to you.

                                     Vision Coverage
                                     TNJH offers vision insurance through  EyeMed Vision Care. The chart below is a brief outline of
                                     the plan. Please refer to the summary plan description for complete plan details.
                                    Benefit                In-Network          Out-of-Network          Frequency
                                    Exam                 Plan pays 100%           Up to $35          Every 12 months

                                    Lenses
                                     Single Vision      Plan pays 100%                              Every 12 months
                                                                                 Up  to  $25
                                     Bifocal
                                                                                 Up  to  $40
                                     Trifocal
                                                                                 Up to   $55
                                    Frames            Up to $100 (20% discount    Up to $50          Every 12 months
                                                       on balances over $100)

                                    Contacts               Up to $115             Up to $92          Every 12 months



          Your Benefits Guide                                                                                      5
          2019
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