Attention: Commonwealth of Kentucky Employee

Size: px
Start display at page:

Download "Attention: Commonwealth of Kentucky Employee"

Transcription

1 Attention: Commonwealth of Kentucky Employee Delta Dental of Kentucky is offering Delta Dental Premier and Delta Dental PPO. The plan comparison below shows the advantages of each plan. Select the plan that best meets your needs... Option A Delta Dental PPO Option B Delta Dental Premier Deductible $25 Individual/$75 Family $50 Individual/$150 Family Network or any Covered Services Network Out-of-Network licensed provider Preventive and Diagnostic 100% of the 75% of the 100% of the Oral exam, emergency exam, Allowable Amount. Allowable Amount. Allowable Amount. palliative emergency treatment, Deductible does Deductible does Deductible does periapical x-rays, bitewing x-rays, not apply. not apply. not apply. panoramic or complete series, topical fluoride application, prophylaxis, sealants, space maintainers Minor Services 80% of the 60% of the 50% of the Routine fillings, simple Allowable Amount. Allowable Amount. Allowable Amount. extractions, root canal therapy, Subject to deductible. Subject to deductible. Subject to deductible. oral surgery, simple prosthetic repairs Periodontal Services 80% of the 60% of the 50% of the Allowable Amount. Allowable Amount. Allowable Amount. Subject to deductible. Subject to deductible. Subject to deductible. Major Services 50% of the 40% of the 50% of the Crowns, bridges, dentures Allowable Amount. Allowable Amount. Allowable Amount. Subject to deductible. Subject to deductible. Subject to deductible. Rates Single: $19.95 Single: $22.78 For contract year: Dual: $38.30 Dual: $43.74 January 1, December 31, 2016 Family: $65.82 Family: $72.30 Dependents covered to age 26. This plan pays a maximum of $1,000 in benefits per Covered Person during the benefit period. Six-month waiting period on oral surgery, 12-month waiting period on Major Services. Replacement of teeth missing prior to the effective date of this plan is not covered. The benefit period and contract year for this plan is January 1, 2016 through December 31, 2016 If you desire to enroll in either plan, please complete the enrollment form enclosed in this packet and return to Delta Dental of Kentucky, PO Box , Louisville, KY or fax to Delta Dental is excited to have the opportunity to propose both of these plans and give you more choices. Thank you for choosing Delta Dental as your dental carrier.

2 Delta Dental Premier Traditional Dental Option Dental Benefits for State of Kentucky Employees This is not a contract. It is a partial list of benefits and services. For complete details refer to your certificate. Deductible (Each Benefit Period) $50 individual/$150 family Maximum Benefits (Per Covered Person each Benefit Period) $1,000 Age Limitations Dependents covered up to age 26. Diagnostic and Preventive Services u Oral examination (limited to 2 per calendar year) u Palliative emergency treatment u Periapical, bitewing, panoramic or complete series x-ray u Topical fluoride application (up to age 19) u Routine cleanings u Sealants (up to age 16) u Space maintainers (up to age 14) Minor Services u Routine fillings u Simple extractions u Root canal therapy u Simple denture repair u Oral surgery** Major Services* u Inlays or crowns u Prosthetic services (bridges, dentures and partials) u Periodontic services Reimbursement Amount 100% of the Allowable Amount Deductible does not apply Reimbursement Amount 50% of the Allowable Amount Subject to deductible. Reimbursement Amount 50% of the Allowable Amount Subject to deductible. *12-month waiting period for Major Services. Replacement of teeth missing prior to the effective date are not covered. **6-month waiting period for Oral Surgery. RATES FOR CONTRACT PERIOD: Single $22.78 Dual $43.74 Family $72.30 Please note: Dentists who have signed participating agreements with Delta Dental of Kentucky agree to accept the Allowable Amount as payment in full for Covered Services as these terms are defined in the Certificate of Coverage. Each Covered Person is responsible for the amount of Coinsurance, Deductible, and non-covered charges. Dentists who have not signed a participating agreement may bill you directly for any amount of their charge in excess of the Allowable Amount. In cases where the dentist s charges exceed the Allowable Amount, your coinsurance will be larger. Certain procedures require preauthorization and/or are subject to limitations. Dental benefits are offered by Delta Dental of Kentucky, Inc. Registered Mark of Delta Dental Plans Association, Inc

3 Delta Dental PPO Preferred Provider Option Dental Benefits for State of Kentucky Employees This is not a contract. It is a partial list of benefits and services. For complete details refer to your certificate. This dental program allows members to utilize any licensed provider. Members who choose a Delta Dental PPO network provider have the lowest out of pocket expenses and cannot be balance billed. Network Benefits Out of Network Benefits Deductible (Each Benefit Period) $25 individual/$75 family $25 individual/$75 family Maximum Benefits (Per Covered Person each Benefit Period) $1,000 $1,000 Age Limitations Dependents covered up to age 26. Diagnostic and Preventive Services Reimbursement Amount Reimbursement Amount u Oral examination (limited to 2 per calendar year) 100% of the Allowable Amount 75% of the Allowable Amount u Palliative emergency treatment Deductible does not apply Deductible does not apply u Periapical, bitewing, panoramic or complete series x-ray u Topical fluoride application (up to age 19) u Routine cleanings u Sealants (up to age 16) u Space maintainers (up to age 14) Minor Services (Class I, II and III) Reimbursement Amount Reimbursement Amount u Routine fillings 80% of the Allowable Amount 60% of the Allowable Amount u Simple extractions Subject to deductible Subject to deductible. u Simple denture repair u Oral surgery** u Root canal therapy u Periodontic services Major Services (Class IV)* Reimbursement Amount Reimbursement Amount u Inlays or crowns 50% of the Allowable Amount 40% of the Allowable Amount u Prosthetic services (bridges, dentures and partials) Subject to deductible Subject to deductible. *12-month waiting period for Major Services. Replacement of teeth missing prior to the effective date are not covered. **6-month waiting period for Oral Surgery. RATES FOR CONTRACT PERIOD: Single $19.95 per month Dual $38.30 per month Family $65.82 per month Please note: Dentists who have signed participating agreements with Delta Dental of Kentucky agree to accept the Allowable Amount as payment in full for Covered Services as these terms are defined in the Certificate of Coverage. Each Covered Person is responsible for the amount of Coinsurance, Deductible, and non-covered charges. Dentists who have not signed a participating agreement may bill you directly for any amount of their charge in excess of the Allowable Amount. In cases where the dentist s charges exceed the Allowable Amount, your coinsurance will be larger. Certain procedures require preauthorization and/or are subject to limitations. Dental benefits are offered by Delta Dental of Kentucky, Inc. Registered Mark of Delta Dental Plans Association, Inc

4 How to find a Delta Dental participating provider First, determine the Delta Dental plan(s) you are looking at for your dental benefits. You can find the plan name on the benefit summary supplied by your employer or on your identification card. t Delta Dental PPO In-network benefits are available through providers who participate in the Delta Dental PPO network. (See your benefit summary for specific coverage levels by network.) t Delta Dental Premier In-network benefits are available through providers who participate in the Delta Dental Premier network. (See your benefit summary for specific coverage levels by network.) t DeltaCare Benefits are available only through providers who participate in the DeltaCare network. t Delta Dental PPO Plus Premier In-network benefits are available through providers who participate in either the Delta Dental PPO or Delta Dental Premier networks. (See your benefit summary for specific coverage levels by network.) Second, choose one of the following methods to identify a participating provider who is in your plan: Internet If you have access to the Internet, you may use our website ( and request the information by city, state, zip code, provider s name or specialty. Mobile App Our mobile app is available for mobile devices using ios (Apple or Andriod). To download, visit the App Store (Apple) or Google Play (Android) and search for Delta Dental. The dentist search tool makes it easy to search for a Delta Dental Premier or Delta Dental PPO dentist in your area. DeltaCare subscribers must go to our website ( to find participating providers. Fax Back If you have access to a fax machine, you may call the Delta Dental customer assistance line at (select option 4) and request a directory by zip code and it will be faxed to you momentarily. Telephone You may call the Delta Dental customer assistance line at (select option 4) and request a list of providers by zip code and the system will read those selections to you. Customer Service You may call a Delta Dental customer service representative at the same toll free number listed above and ask if your provider is participating in the network associated with the plan that you have chosen. Call Your Provider You should call your provider s office and ask if he/she participates in the network associated with the plan that you have chosen. It is important that you verify a provider s status each time you seek care as a provider contract may change. It is your responsibility to verify that the provider you use is contracted with the Delta Dental network associated with the plan that you have chosen. If you receive treatment from a non-network provider, your benefits may be paid at a lower percentage or you may be balance billed. Registered Marks Delta Dental Plans Association DDPK PROV R. 6/14 Underwritten by Delta Dental of Kentucky

5 Your hearing health care program - for life The following program is brought to you by Delta Dental of Kentucky Amplifon Hearing Health Care Overview Custom hearing solutions - we find the solution that best fits your lifestyle and your budget from one of our 10 manufacturers. Risk-free 60-day trial - 100% money-back guarantee. Hearing aid low price guarantee - if you find the same product at a lower price, bring us the local quote and we ll not only match it, we ll beat it by 5%! Continuous Care - one year free follow-up, two years of free batteries, and a three-year warranty. Don t delay - call to schedule your appointment today! Accessing your benefits is as easy as... 1 Call Amplifon at and a Patient Care Advocate will assist you in finding a hearing care provider near you. 2 Our advocate will explain the Amplifon process, request your mailing information and assist you in making an appointment with a hearing care provider. 3 Amplifon will send information to you and the hearing care provider. This will ensure your Amplifon discounts are activated. Registered Marks Delta Dental Plans Association 2015 Amplifon Hearing Health Care, Corp. 2591MISC/DDKY Amplifon ID Card HearPO has changed its name to Amplifon Hearing Health Care. Special money saving offer! Keep this card for future access to: Discounted hearing testing Low price guarantee 60-day risk-free trial period 2 years batteries with purchase To activate your benefit, call today! *This is not health insurance. Call today for your FREE hearing screening appointment! Please bring this offer with you to your appointment. Call today! Hurry! Offer expires on March 31st, 2016! This is not a medical exam and is only intended to assist with amplification selection.

6 See better live better Delta Dental Vision provided by EyeMed Vision Care Your eyes say a lot about you from your emotions to vision and your overall health. And, when you re proactive about protecting your eyes, the impact is clear. Regular eye exams not only correct vision problems, they also can reveal early warning signs of more serious health conditions such as hypertension, cardiovascular disease and diabetes. So, schedule exams annually and you ll be set on a path to better health. Keep on saving You can use your EyeMed discount as often as you like, all year long, on nearly all your vision care purchases at EyeMed s participating providers. Visit eyemed.com to learn more Need to locate a provider? Want to learn about vision wellness? Visit eyemedvisioncare.com/deltadental. Locate a provider You love choices - and so do we. That s why our network has thousands of independent doctors and retail providers. Schedule an appointment Call ahead or stop by one of the many providers that offer walk-ins. Most also have evening and weekend hours to fit any schedule. Show your ID card When you arrive, let the provider know you have an EyeMed discount through Delta Dental. Please note your discount cannot be combined with any other discounts, coupons or promotional offers. Member/Patient Services: ACCESS DISCOUNT PLAN DELTA DENTAL Discount Plan#: Signature: This is not insurance. Dependents are eligible. Please detach carefully at perforation and keep card in your wallet.

7 Delta Dental Discount plan Access network Discounted exam and a defined materials discount Vision care services Exam and dilation as necessary Member cost $5 off routine exam $10 off contact lens exam Complete pair of glasses purchase*: Frame, lenses and lens options must be purchased in the same transaction to receive full discount. Standard plastic lenses: Single Vision $50 Bifocal $70 Trifocal $105 Frames 35% off retail price Lens options: UV treatment $15 Tint (solid and gradient) $15 Standard plastic scratch coating $15 Standard polycarbonate $40 Standard progressive lens (Add-on to bifocal) $65 Standard anti-reflective coating $45 Other add-ons and services 20% off retail price Contact lens materials: (Discount applied to materials only) Disposable Conventional Laser vision correction**: LASIK or PRK Frequency: Examination Frame Lenses Contact lenses 0% off retail price 15% off retail price 15% off retail price or 5% off promotional price Unlimited Unlimited Unlimited Unlimited THIS IS NOT INSURANCE *Items purchased separately will be discounted 20% off of the retail price. **Since LASIK and PRK vision corrections are elective procedures, performed by specially trained providers, this discount may not always be available from a provider in your location. For a location near you and the discount authorization, please call LASER6. Member will receive a 20% discount on those items purchased at participating providers that are not specifically covered by this discount. The 20% off discount does not apply to EyeMed providers' professional services or contact lenses. Retail prices may vary by location. All discounts cannot be combined with any other discounts or promotional offers. This discount design is offered with the EyeMed Access panel of providers. EyeMed Member/ Patient Services: Visit eyemed.com or call the number on the front of this card. EyeMed Doctors/ Providers Only: Visit eyemed.com to receive plan information or authorization online or call Limitations/Exclusions: Orthoptic or vision training, subnormal vision aids and any associated supplemental testing Medical and/or surgical treatment of the eye, eyes or supporting structures Corrective eyewear required by an employer as a condition of employment and safety eyewear unless specifically covered under plan Services provided as a result of any Worker s Compensation law Discount is not available on those frames where the manufacturer prohibits a discount Visit eyemedvisioncare.com/deltadental for more information or to locate a provider near you.

8 Arkansas (800) Kentucky (800) Michigan, Ohio and Indiana (800) New Mexico (877) North Carolina (800) Tennessee (800) With DASI, you re able to access coverage and claims information 24 hours a day, 7 days a week. What do you need to use DASI? Members, clients and other non-dental office callers need to provide the subscriber s member number (usually Social Security number), relationship of the patient/member to the subscriber and the date of birth of the patient/member. What information is available? With DASI, you can receive the following for any Delta Dental of Arkansas, Indiana, Kentucky, Michigan, New Mexico, North Carolina, Ohio or Tennessee member: Eligibility Current effective date of coverage Eligibility for specific benefits (exams, cleanings, fluoride, X-rays, and occlusal guard) ID cards by fax or mail Fax copies of benefits and eligibility, explanation of benefits, and pre-treatment estimates Lists of participating dentists via voice, fax or mail Mailing address information Claim and pre-treatment estimate status Check status for paid claims Maximums and deductibles, including amount met to date and services that apply Coordination of benefits allowances To assist you in navigating the system most efficiently, the main menu is listed here. Listening to the entire menu is not necessary. Once you become familiar with the system and know what information you want, you can speak or press the digits on your touch-tone keypad and go directly to the data. At the greeting: SAY SUBSCRIBER or PRESS 2 DASI will then offer the following menu of choices: SAY COVERAGE INFORMATION 1 or PRESS 1 for general eligibility, availability of benefits for services with time limitations (cleanings, exams and more), FaxBack of benefits and eligibility, and maximums and deductibles. SAY FIND A DENTIST or PRESS 2 to find an in-network dentist. SAY ID CARDS or PRESS 3 to receive an ID card by fax or mail. SAY SOMETHING ELSE or PRESS 4 for additional content. Within the something else menu: SAY CLAIMS 1 or PRESS 1 for claim and pre-treatment estimate status, process dates, check date, check status, and fax copy of a processed claim or pretreatment estimate. SAY TOOLKIT SUPPORT 1 or PRESS 2 to be transferred to a Consumer Toolkit support representative. SAY DELTA DENTAL S MAILING ADDRESS or PRESS 3 to hear the mailing address for claims and inquiries. SAY REPRESENTATIVE or PRESS 4 to speak with a customer service representative. 1 Member number and patient s date of birth required DASI-ERC-MBR v5 PA 8/15

9 Stay informed about your dental benefits with Consumer Toolkit Stay current on your dental benefits with Delta Dental of Kentucky s easy-to-use Consumer Toolkit. This secure online tool is designed to give you 24/7 access to important information regarding your dental benefits, including: Eligibility information Current benefits information (such as how much of your yearly benefit has been used to date, how much is still available to use, and levels of coverage for specific dental services, etc.) Specific claims information, including what has been approved and when it was paid The site also allows you to sign up for electronic delivery of Explanation of Benefits (EOB) statements, print claim forms and identification cards, and browse oral health information. All users must first register to gain access to the Consumer Toolkit. Privacy of your online benefit information is assured through highly secure encryption technology. Get started today To start taking advantage of this innovative tool, follow these simple steps: 1. Visit 2. Select Consumer Toolkit from the drop-down Toolkit menu on the homepage. 3. Register as a new Toolkit user by clicking the New User button. NOTE: You will need the subscriber s (the person whose name is on the benefit package) member ID. The member ID is an assigned number unique to the subscriber. In most cases, the member ID is the same as the subscriber s Social Security number. 4. Complete required fields and follow the on-screen instructions. 5. Select your own username and password to access the site. Additional help topics can be found by selecting Help or clicking the at any time within the Toolkit. If you need further assistance, please contact our Customer Service department at (800) Mobile App Eligibility Up-to-date benefit information Delta Dental s mobile app is available for mobile devices using ios (Apple) or Android. To download and install the app on your device, visit the App Store (Apple) or Google Play (Android) and search for Delta Dental. The app provides the ability to search for a Delta Dental Premier or Delta Dental PPO SM dentist in your area (DeltaCare members must go to our website at to find participating providers), check your claims and coverage information on the go, get estimated cost ranges for common dental services, and access a mobile ID card that you can show your dental office. CTK-RC-KY v3 9/15 PA

10 Please check the plan you have selected: DELTA DENTAL PREMIER DELTA DENTAL PPO COMMONWEALTH OF KENTUCKY ENROLLMENT/STATUS CHANGE FORM NEW ENROLLMENT Social Security Number Name Last First MI Home Phone STATUS CHANGE PLEASE NOTE: New enrollments received by the 14 th of the month are effective the 1 st of the following month. Name and address of Agency or Cabinet where you are employed for payroll deductions Home Address Number and Street ( ) City State Zip THIS SECTION FOR OFFICE USE ONLY PPO Rates Single - $19.95 Employee/Spouse or Employee/One Child - $38.30 Family - $65.82 MEMBERS List all members below. If additional space is required, attach a list to this form. Last First MI Policyholder Group Number M00146 Section Number Begin Effective Date Date of Birth MO DAY YR Birthdate / / M Sex F FULL-TIME STUDENT YES NO Date Employed / / Change Effective Date Sex (Circle one) M or F Please check the type of contract you have selected (Monthly rates for January 1, December 31, 2016): Premier Rates Single - $22.78 Employee/Spouse or Employee/One Child - $43.74 Family - $72.30 Does member have other dental coverage? If so, give insurance company name and telephone number, policyholder s name and identification number. Spouse Dependent Dependent Dependent STATUS CHANGES ONLY (Complete all that apply.) Change type of contract to: Single Employee/Spouse or Employee/Child(ren) Employee/Spouse/Child(ren) Name Change: Previous Name: New Name: Address Change: Dependent Add or Delete (circle one): Name: Birthdate: Reason: Marriage Divorce Death Date: Dependent No Longer Eligible Reason: PLEASE REVIEW YOUR ENROLLMENT FORM FOR ERRORS OR OMISSIONS. I acknowledge that I have read the provisions of the back of this enrollment form and I expressly accept such provisions as a condition of coverage. I represent the answers given to all questions on this form are true and accurate to the best of my knowledge and I understand they are being relied on by Delta Dental of Kentucky in accepting this form. Any material misrepresentation found in this application may result in denial of benefits or cancellation of my coverage(s). Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. If accepted, this form, the member certificate, the identification card, and the group contract will constitute the contract. Signature Date Please make a copy for your records and mail the original to Delta Dental of Kentucky, PO Box , Louisville, KY Registered Mark of Delta Dental Plans Association. R. 9/15

11 ENROLLMENT FORM FOR GROUP COVERAGE In consideration of the acceptance of this enrollment form, I represent and agree for myself and my dependents that: 1. My coverage, and that of any dependents, will become effective on the date established by my dental contract (referred to as Plan ). I agree to be bound by the provisions of the Group Contract(s) and Certificates of Coverage issued to me. Any dependents who are later added to my Plan may have different effective dates. 2. I understand that all benefits payable under my dental contract for services rendered by any participating provider will be paid to such provider. Payment for services rendered by a non-participating provider will be sent to me. 3. My employer or group administrator is authorized to deduct from my pay, as stated on the Flexible Benefits Enrollment form, my share of dental premiums from my wages for 12 months and 12 month renewal periods, and is authorized to remit a premium to the Plan and to receive all notices from the Plan relating to my coverage. I understand that enrollments are by Group Contract for consecutive 12 month period(s) and my subscription fee is subject to change on the anniversary date of the Group. Further, I understand that non-compliance with these terms would void any benefits during that enrollment period. 4. I am responsible to notify the Plan upon any change that would make me or any dependent ineligible for coverage. 5. I will cooperate with the Plan and furnish all information requested by the Plan to enforce its right of subrogation and to coordinate benefits. Subrogation is the Plan s right to recover from a third party that may be liable to me for any injury which resulted in Dental Services paid by the Plan. 6. I will reimburse the Plan for any erroneous payment and the Plan may offset these amounts against future claim payments. 7. Any omitted or incorrect information or false statements made here may, at the sole options of the Plan, void or terminate my coverage or result in denial of services or benefits otherwise available hereunder for me or my dependents. My benefits will be voided for the entire enrollment period, and I must reimburse the Plan if the Plan has already paid the dentist, at the dentist s normal fee for service, for any services or benefits received by me or my dependents during that 12 month period. I consent that any subscription fees paid to the Plan during that period will be retained by the Plan to cover administrative expenses. I understand and agree that no agent has the authority to waive a complete answer to any questions, make a determination as to applicable underwriting or eligibility requirements, make or alter any contract, or waive any of the Plan s other rights or requirements. 8. My employer, any other organization or person, any provider of dental care, any insurance company or insurance support agency, is hereby authorized to give the Plan any information about me and my listed dependents necessary for determining eligibility for insurance, benefits, risk classification, detecting or preventing fraud or misrepresentation, audits, and for claims administration purposes. This authorization includes any records or knowledge about my medical history, mental or physical condition, diagnosis, treatment or prognosis, including information relating to the use of drugs or alcohol. This information may also be given by the Plan to its legal representatives and reinsurers. 9. To the extent allowed by law, the Plan is authorized to furnish all information and copies of records requested by other insurers, dental plans or other parties for the purposes of determining eligibility for coverage or benefits, coordinating benefits, exercising the right of subrogation, utilization review or audit. I give the Plan, its legal representatives or any person or organization administering claims on its behalf, permission to release to my employer or group policyholder a summary of claims incurred by me or my eligible dependents for the purpose of verifying the claims submitted under my group health plan, utilization review, or for the purpose of conducting an audit of operations or services. If my benefits are provided under a self-funded plan, the above listed parties are authorized to release any necessary information to the self-funded plan, and I understand that all information under the Plan are the property of my employer and may be retained by my employer. 10. Any material misrepresentation found in this application may result in denial of benefits or cancellation of my coverage(s). Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals for the purpose or misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. If accepted, this application, the identification card and the group contract will constitute the contract. 11. I understand that there can be no change in my coverage unless a change in family status occurs as defined: marriage or divorce; death of spouse or dependent; birth or adoption of a dependent; spouse commences or terminates employment; employee or spouse changes between full-time and part-time employment; or unpaid leave of absence for employee or spouse. I also understand that it is my responsibility to notify my employer within 30 days of change in family status. PLEASE SIGN APPLICATION ON FRONT

Delta Dental of Wisconsin 2015 Open Enrollment Materials. For AFSCME Council 24, Wisconsin State Employees Union

Delta Dental of Wisconsin 2015 Open Enrollment Materials. For AFSCME Council 24, Wisconsin State Employees Union Delta Dental of Wisconsin 2015 Open Enrollment Materials For AFSCME Council 24, It s open enrollment time. Follow the steps to edit your current coverage or enroll in the plan. If you are currently enrolled

More information

Individual Dental Insurance

Individual Dental Insurance Individual Dental Insurance From Delta Dental of Wisconsin Be your own individual with dental plans from the most trusted name in dental benefits. Plan designs and rates subject to change without notice.

More information

Delta Dental Individual and Family DENTAL AND VISION PLANS AT A PRICE THAT WILL MAKE YOU SMILE.

Delta Dental Individual and Family DENTAL AND VISION PLANS AT A PRICE THAT WILL MAKE YOU SMILE. Delta Dental Individual and Family DENTAL AND VISION PLANS AT A PRICE THAT WILL MAKE YOU SMILE. WHY DENTAL INSURANCE? To improve your health People with dental insurance typically visit the dentist more

More information

OUTLINE OF COVERAGE HEALTH NET LIFE INSURANCE COMPANY INDIVIDUAL MEDICARE SUPPLEMENT OPTIONAL SUPPLEMENTAL BENEFITS GUIDE

OUTLINE OF COVERAGE HEALTH NET LIFE INSURANCE COMPANY INDIVIDUAL MEDICARE SUPPLEMENT OPTIONAL SUPPLEMENTAL BENEFITS GUIDE OUTLINE OF COVERAGE HEALTH NET LIFE INSURANCE COMPANY INDIVIDUAL MEDICARE SUPPLEMENT OPTIONAL SUPPLEMENTAL BENEFITS GUIDE Health Net Life Insurance Company Individual Medicare Supplement plans provides

More information

Kaiser Permanente and Delta Dental

Kaiser Permanente and Delta Dental Kaiser Permanente and Delta Dental Dental Program for Kaiser Permanente FEHBP Enrollees You must be a Kaiser Permanente FEHBP enrollee to participate in the dental plan. Kaiser Permanente and Delta Dental

More information

2015 Insurance Benefits Guide. Vision Care. Vision Care. www.eip.sc.gov S.C. Public Employee Benefit Authority 105

2015 Insurance Benefits Guide. Vision Care. Vision Care. www.eip.sc.gov S.C. Public Employee Benefit Authority 105 2015 Insurance Benefits Guide www.eip.sc.gov S.C. Public Employee Benefit Authority 105 Insurance Benefits Guide 2015 Table of Contents Introduction...107 State Vision Plan...107 Vision Benefits at a Glance...

More information

Federal Employee Dental and Vision Options

Federal Employee Dental and Vision Options Federal Employee Dental and Vision Options 2016 Guide for Presbyterian Health Plan Members For more information: 1804 Juan Tabo NE, Suite A, Albuquerque, NM 87112 888 862 8659 505 237 1501 benefitsource.org

More information

Good news about dental benefits for employees of NORTHWEST FLORIDA STATE COLLEGE

Good news about dental benefits for employees of NORTHWEST FLORIDA STATE COLLEGE Voluntary Dental PPO (BASIC PLAN) Good news about dental benefits for employees of Your Dental Plan As a valued employee of, you have the opportunity to enroll in a payroll-deduction dental program. Plan

More information

Quality. Vision Care. for Groups Big and Small. Plus & Materials Only Plans GROUPS 2+

Quality. Vision Care. for Groups Big and Small. Plus & Materials Only Plans GROUPS 2+ Vision Care Quality for Groups Big and Small Plus & Materials Only Plans GROUPS 2+ Offer your group clients a fully insured vision plan that provides one of the greatest values in the vision care industry.

More information

MetLife Group Dental Insurance

MetLife Group Dental Insurance The University of Alabama at Birmingham Dental Plan Benefits For the savings you need, the flexibility you want and service you can trust. Comprehensive Plan Plan Option 2 Benefit Summary Coverage Type

More information

Delta Dental Individual and Family

Delta Dental Individual and Family Delta Dental Individual and Family for the Arkansas Retired Teachers Association DENTAL AND VISION PLANS AT A PRICE THAT WILL MAKE YOU SMILE. WHY DENTAL INSURANCE? To improve your health People with dental

More information

The EyeMed Network. EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, Oh 45040-7111

The EyeMed Network. EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, Oh 45040-7111 The following is a summary of the vision benefits for Unity Health System. This document is not the Summary Plan Description document Plan Information Unity Health System has selected EyeMed Vision Care

More information

Anthem BCBS PPO 80/60. Network Out-of-Network Network Out-of-Network Network Out-of-Network $1,750 per person. $2,500 per person $5,000 per family

Anthem BCBS PPO 80/60. Network Out-of-Network Network Out-of-Network Network Out-of-Network $1,750 per person. $2,500 per person $5,000 per family Plan PPO 90/70 PPO 80/60 PPO 75/50 Annual Medical Deductible Network Out-of-Network Network Out-of-Network Network Out-of-Network $250 per person $500 per person $500 per person $1,000 per person $900

More information

HDHP/HSA. $3,000 per person $6,000 per family (deductible includes medical & prescriptions) $7,000 per person $13,000 per family

HDHP/HSA. $3,000 per person $6,000 per family (deductible includes medical & prescriptions) $7,000 per person $13,000 per family Plan Aetna Select EPO BCBS PPO 90/70 BCBS HDHP/HSA High Option EPO EPO 80 Choice Choice Plus 80/60 Annual Medical Deductible Annual Out-of-Pocket Maximum (includes deductible) Network Only Network Out-of-Network

More information

Vision Benefits. January 2013

Vision Benefits. January 2013 Vision Benefits January 2013 As a benefits-eligible associate at Advocate, you have the opportunity to choose optional coverage providing benefits for vision care services. This coverage featuring primary

More information

City State Zip LIST ALL YOUR ELIGIBLE DEPENDENTS BELOW Last Name (If Different) First Name Initial M/F Birth Date (M/D/Y) o o / / Spouse

City State Zip LIST ALL YOUR ELIGIBLE DEPENDENTS BELOW Last Name (If Different) First Name Initial M/F Birth Date (M/D/Y) o o / / Spouse Dental Insurance Plan Enrollment Card MAIL FORM TO: Security Life Ins. Company of America Enroll Online at: www.landmark-dental.com PO Box 27810 Minneapolis, MN 55427-0810 Choose your plan: o PPO o Open

More information

Delta Dental of New Jersey

Delta Dental of New Jersey Delta Dental of New Jersey With Delta Dental, You Get These Important Features Comprehensive preventive, basic and major dental coverage Choice of two excellent plans... so you can select the one that

More information

(1) may be provided under contract with another health care insurer;

(1) may be provided under contract with another health care insurer; Sec. 21.42.385. Dental, vision, and hearing coverage. (a) Except for a fraternal benefit society, a health care insurer that offers, issues for delivery, delivers, or renews in this state a health care

More information

Dental and vision coverage for your total health

Dental and vision coverage for your total health Dental and vision coverage for your total health The mouth and eyes are important parts of your body, and your health. Regular dental and vision checkups can help nd early warning signs of disease. So

More information

The Railroad Employees National Vision Plan

The Railroad Employees National Vision Plan The Railroad Employees National Vision Plan Effective January 1, 2013, your Vision Plan benefits will be provided by EyeMed Vision Care. There is no change to the Plan design but there will be a few enhancements.

More information

DeltaVision. DeltaVision. Insured vision plans from Delta Dental of Wisconsin.

DeltaVision. DeltaVision. Insured vision plans from Delta Dental of Wisconsin. DeltaVision DeltaVision Insured vision plans from Delta Dental of Wisconsin. We know what matters to you. Great vision benefits; no joke. Great vision benefits; no joke. Delta Dental asks groups and agents

More information

Right Product, Right Service, Right Enrollment

Right Product, Right Service, Right Enrollment Right Product, Right Service, Right Enrollment Dental Insurance Member Dental & Vision Benefits Automotive Service Association Vision Insurance As a member of the Automotive Service Association, we wish

More information

Premium Chart for Aetna Term Life Insurance

Premium Chart for Aetna Term Life Insurance Premium Chart for Aetna Term Life Insurance Physician Premiums PLEASE NOTE 1) Your premium amount is the number located in the table cell where your age and desired coverage intersect. Up to $200,000 in

More information

Vision Care Program. Vision Discounts Voluntary Vision Benefits LASIK Discounts

Vision Care Program. Vision Discounts Voluntary Vision Benefits LASIK Discounts Vision Care Program Vision Discounts Voluntary Vision Benefits LASIK Discounts Vision Care Program by EyeMed Easy to use Simply visit the participating provider closest to you and present your Vision Care

More information

Your Preferred Dental Organization Member Handbook Dentist Directory

Your Preferred Dental Organization Member Handbook Dentist Directory Your Preferred Dental Organization Member Handbook Dentist Directory & FOR Delta Dental of Tennessee provides benefits that are easy to use. See inside for details on how your dental plan can help protect

More information

Dental Plan General Information

Dental Plan General Information Dental Plan General Information CSU offers two dental plans for employees to choose from: Delta Dental Basic and Delta Dental Plus. Both plans are self-insured and administered, including claims processing,

More information

OPTION #2 COMPANION LIFE DENTAL INSURANCE PLAN SELECT ANY DENTIST

OPTION #2 COMPANION LIFE DENTAL INSURANCE PLAN SELECT ANY DENTIST OPTION #2 COMPANION LIFE DENTAL INSURANCE PLAN SELECT ANY DENTIST A Dental Plan for Groups of Three or More Covered Services Description SELECT ANY DENTIST Preventive, Basic, and Major services are subject

More information

US Airways Medicare Options US Trust 2015 Benefits Guide

US Airways Medicare Options US Trust 2015 Benefits Guide US Airways Medicare Options US Trust 2015 Benefits Guide Welcome to the 2015 Medicare Options US Trust Retiree Benefit Plans This guide includes detailed information regarding the benefit options available

More information

The Standard Select SM Group Dental Insurance Flexible Dental Plans for Small Businesses

The Standard Select SM Group Dental Insurance Flexible Dental Plans for Small Businesses The Standard Select SM Group Dental Insurance Flexible Dental Plans for Small Businesses STANDARD INSURANCE COMPANY Your Proposed Group Insurance Plan Standard Insurance Company appreciates the opportunity

More information

Employee Benefits. Health Insurance

Employee Benefits. Health Insurance Employee Benefits The Taylor County Board of Education is dedicated to hiring and retaining employees who are committed to excellence in education. We reward our employees by providing a competitive salary

More information

Employee Benefits Summary. Plan Year 2015/16

Employee Benefits Summary. Plan Year 2015/16 Employee Benefits Summary Plan Year 2015/16 WELCOME -3- Mount Ida College offers a competitive benefits package to all eligible faculty and staff. The following is a summary of the benefit plans offered.

More information

Dental Savings Plus. Keep your smile healthy and enjoy immediate savings on adult and child dental services with your HumanaOne Dental

Dental Savings Plus. Keep your smile healthy and enjoy immediate savings on adult and child dental services with your HumanaOne Dental HumanaOne Dental Savings Plus This dental discount plan delivers immediate discounts on dental care plus other services, such as vision, prescription, hearing and alternative medicine, to help you and

More information

Phone 1(671) 646-3741 Fax 1 (671) 646-3740 278 South Marine Drive, Hengi Plaza, Suite 203, Tamuning, Guam 96913. Dental Plan Application Packet

Phone 1(671) 646-3741 Fax 1 (671) 646-3740 278 South Marine Drive, Hengi Plaza, Suite 203, Tamuning, Guam 96913. Dental Plan Application Packet Phone 1(671) 646-3741 Fax 1 (671) 646-3740 278 South Marine Drive, Hengi Plaza, Suite 203, Tamuning, Guam 96913 Plan: 1023 Plan: 1777 1 year contract for Adult $417.60 1 year contract for Adult $371.52

More information

EMPLOYEE DENTAL PLANS

EMPLOYEE DENTAL PLANS EMPLOYEE DENTAL PLANS State Health Benefits Program ELIGIBILITY The Employee Dental Plans are available to full-time State employees, full-time employees of a local employer (county, municipality, school

More information

2 Medical Health Insurance Plans Dental Plan Option Vision Plan Option

2 Medical Health Insurance Plans Dental Plan Option Vision Plan Option STUDENT OSTEOPATHIC MEDICAL ASSOCIATION 2013-2014 SCHOOL YEAR PLAN SUMMARIES COLLEGE HEALTH INSURANCE PROGRAM 2 Medical Health Insurance Plans Dental Plan Option Vision Plan Option The 2013-2014 complete

More information

Dental Benefits. How Dental Benefits Work. Schedule of Benefits

Dental Benefits. How Dental Benefits Work. Schedule of Benefits Dental coverage under Stryker s healthcare plan helps pay dental bills for you and your family. It is designed to encourage good dental care. The plan covers preventive dental services and treatment for

More information

Affordable dental plan and package options for Medicare Supplement plan members

Affordable dental plan and package options for Medicare Supplement plan members Affordable dental plan and package options for Medicare Supplement plan members Last updated: November 2014 Blue Shield of California rates effective: August 1, 2014 Something to smile about Make the choice,

More information

Health Insurance Enrollment Form

Health Insurance Enrollment Form Health Insurance Enrollment Form Complete the Enrollment Form to Elect or Decline Coverage You MUST Complete the Enrollment Form for the New Hire Process You MUST Elect or Decline Medical Coverage on the

More information

Statewide Vision Program EyeMed Vision Care Plan - Frequently Asked Questions

Statewide Vision Program EyeMed Vision Care Plan - Frequently Asked Questions Statewide Vision Program EyeMed Vision Care Plan - Frequently Asked Questions Q. Who is eligible to enroll? A. Active State of Delaware employees, pensioners, Long Term Disability (LTD) recipients, and

More information

Paulding County School District Dental Plan Benefits

Paulding County School District Dental Plan Benefits Paulding County School District Dental Plan Benefits Network: PDP Plus Benefit Summary Plan Option 1 High Plan Plan Option 2 Low Plan Coverage Type In-Network Out-of-Network Coverage Type In-Network Out-of-Network

More information

Employee Benefits Summary. Plan Year 2014/15

Employee Benefits Summary. Plan Year 2014/15 Employee Benefits Summary Plan Year 2014/15 WELCOME -3- Mount Ida College offers a competitive benefits package to all eligible faculty and staff. The following is a summary of the benefit plans offered.

More information

National Automatic Sprinkler Industry Welfare Fund. Benefits Highlights

National Automatic Sprinkler Industry Welfare Fund. Benefits Highlights National Automatic Sprinkler Industry Welfare Fund Benefits Highlights 2014 This Benefits Highlights booklet does not contain the full plan document and is not a Summary Plan Description for the NASI Welfare

More information

U S F a m i l y H e a l t h P l a n. Value Added Services for our US Family Health Plan Members

U S F a m i l y H e a l t h P l a n. Value Added Services for our US Family Health Plan Members Value Added Services for our US Family Health Plan Members Vision Care Complementary and Alternative Medicine Hearing Aids and Batteries U S F a m i l y H e a l t h P l a n Healthy Vision: The Clear Choice

More information

The UAW Retiree Medical Benefits Trust - Plans and Review

The UAW Retiree Medical Benefits Trust - Plans and Review 2012 Health Care Benefit Highlights Addendum to the 2011 Benefit Highlights, Schedule of Benefits, and Summary Description previously published. Dear UAW Trust Member, The UAW Retiree Medical Benefits

More information

Group Dental Insurance

Group Dental Insurance Standard Select Group Dental Insurance Flexible Dental Plans for Small Business Standard Insurance Company The Standard Life Insurance Company of New York Group Dental Insurance Standard Insurance Company

More information

Plans available in the following states: AL, AZ, CA, CO, DC, DE, HI, KY, MN, ND, NE, NV, OK, OR, SD, TX, UT, VT, WI & WY

Plans available in the following states: AL, AZ, CA, CO, DC, DE, HI, KY, MN, ND, NE, NV, OK, OR, SD, TX, UT, VT, WI & WY Individual & Family Dental Insurance Choose Any Provider Benefit up to $4,000 Preventive Services at 100% National Network Coverage Graduating Basic Service Benefit Discount Vision Included Administered

More information

Dental and Vision for Everyone

Dental and Vision for Everyone Dental and Vision for Everyone Dental and Vision Coverage in One Plan* For Individuals, Small Employers, and Senior Citizens Marketed by: Dental Underwritten by: Vision Administered by: STNDLIFE 0-09 POL-DENT

More information

2015 Lone Star Script Care LLC ALL AGENTS ARE REQUIRED TO READ AND UNDERSTAND ALL OPERATING POLICIES AND PROCEDURES.

2015 Lone Star Script Care LLC ALL AGENTS ARE REQUIRED TO READ AND UNDERSTAND ALL OPERATING POLICIES AND PROCEDURES. 2015 Lone Star Script Care LLC ALL AGENTS ARE REQUIRED TO READ AND UNDERSTAND ALL OPERATING POLICIES AND PROCEDURES. The History of Benefit Plans The aim of discount benefit plans at first was to fill

More information

Dental, vision, and life insurance plans. a complete plan is a better plan. find a plan that fits you. Individual and Family Plans

Dental, vision, and life insurance plans. a complete plan is a better plan. find a plan that fits you. Individual and Family Plans Effective: January 1, 2016 Individual and Family Plans Dental, vision, and life insurance plans find a plan that fits you a complete plan is a better plan Blue Shield offers more than just medical coverage.

More information

2016 Group Dental Member Handbook. For active employees and retirees BENEFITS. State of Tennessee

2016 Group Dental Member Handbook. For active employees and retirees BENEFITS. State of Tennessee 2016 Group Dental Member Handbook For active employees and retirees BENEFITS State of Tennessee Revised on 4/19/2016 Welcome! Why is having a good Dental plan so important? Because a healthier smile can

More information

Dental/Vision/Hearing Expense Insurance

Dental/Vision/Hearing Expense Insurance Dental/Vision/Hearing Expense Insurance Rising healthcare costs can force you into difficult situations including reduced health benefits, loss of benefits, and price increases. Basic Medicare does not

More information

Take control of your total health with the right vision and dental coverage

Take control of your total health with the right vision and dental coverage Take control of your total health with the right vision and dental coverage The mouth and eyes are important parts of your body and your health. Regular dental and vision checkups can help find early warning

More information

PLEASE BRING THE FOLLOWING WITH YOU TO YOUR APPOINTMENT:

PLEASE BRING THE FOLLOWING WITH YOU TO YOUR APPOINTMENT: To Our New Patient: Our primary concern is providing you with excellent eye care. Your understanding of our policies and your cooperation with our procedures enables us to provide this care. Complete eye

More information

Anthem Extras Packages

Anthem Extras Packages Anthem Extras Packages Dental, Vision and more Virginia benefits that complement your Medicare Supplement plan Packaged benefits better together Healthy teeth and eyes help contribute to your overall well-being.

More information

Dental and Vision Plan Information for OSU/A&M System Employees

Dental and Vision Plan Information for OSU/A&M System Employees Employee Benefit Options Guide Plan Year 2016 January 1 through December 31, 2016 Dental and Vision Plan Information for OSU/A&M System Employees www.sib.ok.gov Oklahoma State University/A&M System Monthly

More information

Olentangy Local School District Dental Plan Benefits

Olentangy Local School District Dental Plan Benefits Olentangy Local School District Dental Plan Benefits For the savings you need, the flexibility you want and service you can trust. Benefit Summary Coverage Type PDP In-Network Out-of-Network Type A cleanings,

More information

DENTAL VISION WORK & LIFE SERVICES HEALTH DISCOUNTS

DENTAL VISION WORK & LIFE SERVICES HEALTH DISCOUNTS DENTAL VISION WORK & LIFE SERVICES HEALTH DISCOUNTS Please Note: Oxford Benefit Management, Inc. acts as the distribution company for products by third-party vendors including UnitedHealthcare Dental,

More information

Scott & White Dental Plan Benefits

Scott & White Dental Plan Benefits Scott & White Dental Plan Benefits For the savings you need, the flexibility you want and service you can trust. Benefit Summary Select Plan Enhanced Plan Coverage Type PDP : : Coverage Type PDP : : Type

More information

Coventry Health & Life Insurance Company Small Group PPO Schedule of Benefits:

Coventry Health & Life Insurance Company Small Group PPO Schedule of Benefits: Coventry Health & Life Insurance Company Small Group PPO Schedule of Benefits: Plan ID#: Silver Traditional 3000 90-14 (# ) This Schedule of Benefits summarizes Your obligation towards the cost of certain

More information

Liberty Healthcare Management, Inc. Dental Plan Benefits

Liberty Healthcare Management, Inc. Dental Plan Benefits Liberty Healthcare Management, Inc. Dental Plan Benefits Network: PDP Plus Benefit Summary Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations 100% of Negotiated Fee* 100% of R&C

More information

2014 Evidence of Coverage Optional Supplemental Benefits Attachment Coventry Medicare Advantage Dental Plan (PPO)

2014 Evidence of Coverage Optional Supplemental Benefits Attachment Coventry Medicare Advantage Dental Plan (PPO) 2014 Evidence of Coverage Optional Supplemental Benefits Attachment OPTIONAL SUPPLEMENTAL BENEFITS YOU CAN BUY As explained in Chapter 4, Section 2.2 of this Evidence of Coverage, our plan offers some

More information

DVH PLUS with Coverage Schedule CSA58PP

DVH PLUS with Coverage Schedule CSA58PP Medico Insurance Company Dental, Vision & Hearing Plan Form A58 DVH PLUS with Coverage Schedule CSA58PP Premium Rates by Mode Monthly Automatic Bank Withdrawal Quarterly Automatic Bank Withdrawal Issue

More information

Choice, Service, Savings. To help you enroll, the following pages outline your company's dental plan and address any questions you may have.

Choice, Service, Savings. To help you enroll, the following pages outline your company's dental plan and address any questions you may have. Plan Design for: Unitarian Universalist Association of Congregations Effective Date: October 01, 2002 Amendment Effective Date ± : January 01, 2013 Date Prepared: January 01, 2015 Choice, Service, Savings.

More information

A DENTAL PLAN THAT BALANCES CHOICE & SAVINGS

A DENTAL PLAN THAT BALANCES CHOICE & SAVINGS A DENTAL PLAN THAT BALANCES CHOICE & SAVINGS GuideStone s Choice Dental Plan Cigna Total DPPO The Cigna Total Dental PPO (DPPO) network makes it easy to protect your health and your smile with the right

More information

Welcome! We look forward to serving you!

Welcome! We look forward to serving you! Welcome! Getting your eyes checked can help you be the vision of health. You may think you need an eye exam only when it s time to update your eyewear prescription. But the truth is, an eye exam can spot

More information

COMPARISON OF BENEFITS* FOR CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES

COMPARISON OF BENEFITS* FOR CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES COMPARISON OF BENEFITS* FOR CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES Effective July 1, 2016 Medical/Vision/Pharmacy coverage is administered by PacificSource Health Plans Dental coverage is administered

More information

Health Insurance Enrollment Form

Health Insurance Enrollment Form Health Insurance Enrollment Form Complete the Enrollment Form to Elect or Decline Coverage You MUST Complete the Enrollment Form for the New Hire Process You MUST Elect or Decline Medical Coverage on the

More information

SCHEDULE OF BENEFITS. Group Access Care Comprehensive Health Insurance Policy

SCHEDULE OF BENEFITS. Group Access Care Comprehensive Health Insurance Policy SCHEDULE OF BENEFITS Classes of Employees Insured: [Class 1 All Active Full-Time Indian Employees] [Monthly Premium Rates: Individual - [$ 398.34] Two-Person [$796.68] Family Coverage [$1,210.66]] Benefit

More information

Delta Dental Insurance Company. VIVA Medicare Plus Extra Care Dental Program. Evidence of Dental Coverage

Delta Dental Insurance Company. VIVA Medicare Plus Extra Care Dental Program. Evidence of Dental Coverage Delta Dental Insurance Company VIVA Medicare Plus Extra Care Dental Program Evidence of Dental Coverage January 1, 2008 to December 31, 2008 If you have questions about your dental benefits, you may contact

More information

Kaukauna Area School District Employee Benefits Booklet 2015. Kaukauna Area School District. 2015 EMPLOYEE BENEFITS GUIDE

Kaukauna Area School District Employee Benefits Booklet 2015. Kaukauna Area School District. 2015 EMPLOYEE BENEFITS GUIDE Kaukauna Area School District Employee Benefits Booklet 2015 Kaukauna Area School District. 2015 EMPLOYEE BENEFITS GUIDE Quick Reference Guide Benefit Vendor Phone & Website Health Network Health Plan

More information

Your Dental Benefits The Local Choice

Your Dental Benefits The Local Choice Your Dental Benefits The Local Choice Retiree Health Benefits Program for Medicare-Eligible Retirees and their Medicare-Eligible Dependents Welcome to Delta Dental of Virginia In addition to the largest

More information

Anthem Blue Dental PPO Plan

Anthem Blue Dental PPO Plan Anthem Blue Dental PPO Plan For Individuals and Families Anthem Blue Cross and Blue Shield 700 Broadway Denver, Colorado 80273 anthem.com An independent licensee of the Blue Cross and Blue Shield Association.

More information

HEALTH CARE DENTAL CARE

HEALTH CARE DENTAL CARE UNIVERSITY OF DAYTON MEDICARE SUPPLEMENT PLAN OPEN ENROLLMENT HEALTH CARE DENTAL CARE 2016 Office of Human Resources 300 College Park Dayton, OH 45469-1614 Phone 937-229-2541 Fax 937-229-2009 O65 1 Health

More information

Performance Plus Dental Plan. Annual Deductible. Dental Benefit Maximums. Prior Authorization. Verification of Coverage. Eligible Dental Expenses

Performance Plus Dental Plan. Annual Deductible. Dental Benefit Maximums. Prior Authorization. Verification of Coverage. Eligible Dental Expenses Performance Plus Dental Plan The Trust provides a Dental Plan for Participants the Performance Plus Dental Plan. In-Network Services are available from dentists contracted on behalf of the Trust. Out-of-Network

More information

Dental Plans YOUR GUARDIAN PLAN OFFERS:

Dental Plans YOUR GUARDIAN PLAN OFFERS: Dental Plans Option 1 or 2: With your High Plan or Low Plan plan, you can visit any dentist; but you pay less out-of-pocket when you choose a PPO dentist. COMPARE THE PLANS Option 1: High Plan Option 2:

More information

HIGHMARK VISION COVERAGE MAKES IT EASY TO GET VISION CARE

HIGHMARK VISION COVERAGE MAKES IT EASY TO GET VISION CARE HIGHMARK VISION COVERAGE MAKES IT EASY TO GET VISION CARE You know the importance of vision care. Regular eye exams are an important part of overall preventive health care. According to the Vision Council

More information

Delta Dental benefits for AAA members

Delta Dental benefits for AAA members benefits for AAA members Affordable dental benefits exclusively for AAA Ohio Auto Club members. Good health starts with a healthy smile A healthy smile is important not only to your oral health, but for

More information

Your A&M System Vision Plan

Your A&M System Vision Plan Your A&M System Vision Plan Updated September 2015 INTRODUCTION The Texas A&M University System provides vision benefits to help you p ay for vision care and supplies for yourself and your family. Regular

More information

Balanced Care VisionSM. Choice Vision Insurance that Helps Employers Balance Features and Cost

Balanced Care VisionSM. Choice Vision Insurance that Helps Employers Balance Features and Cost Balanced Care VisionSM Choice Vision Insurance that Helps Employers Balance Features and Cost Standard Insurance Company The Standard Life Insurance Company of New York Standard Insurance Company is licensed

More information

Benefit Year 2016 Voluntary Vision Benefit Summary

Benefit Year 2016 Voluntary Vision Benefit Summary Benefit Year 2016 Voluntary Vision Benefit Summary Customer Service: 800-638-3120 Provider Locator: 800-839-3242 www.myuhcvision.com UnitedHealthcare Vision has been trusted for more than 40 years to deliver

More information

ADN Administrators, Inc. PO Box 610 Southfield, MI 48037 248-901-3705 Utica Community Schools Dental Benefits Plan Group # 9210 Teachers with other dental coverage (COB) The Plan-at-a-Glance Maximum Benefits

More information

Long Term Disability Conversion Insurance Application Instructions For Residents of: AR, CO, DC, KY, LA, NJ, NM, NY, OH, OK, PA, TN

Long Term Disability Conversion Insurance Application Instructions For Residents of: AR, CO, DC, KY, LA, NJ, NM, NY, OH, OK, PA, TN Long Term Disability Conversion Insurance Application Instructions THE RIGHT TO CONVERT If your long term disability (LTD) insurance ends under your Employer s Group LTD Policy from Standard Insurance

More information

Your Dental Benefits. The Local Choice Dental Benefits Program

Your Dental Benefits. The Local Choice Dental Benefits Program Your Dental Benefits The Local Choice Dental Benefits Program Welcome to Delta Dental of Virginia In addition to the largest network of dentists in Virginia* and valuable benefits that help keep your out-of-pocket

More information

Plans available in the following states: AL, AZ, CA, CO, DC, DE, HI, KS, KY, MN, ND, NE, NV, OK, OR, SD, TX, UT, VT, WI & WY

Plans available in the following states: AL, AZ, CA, CO, DC, DE, HI, KS, KY, MN, ND, NE, NV, OK, OR, SD, TX, UT, VT, WI & WY Individual & Family Dental Insurance Choose Any Provider Benefit up to $4,000 Preventive Services at 100% National Network Coverage Graduating Basic Service Benefit Discount Vision Included Administered

More information

DELTA DENTAL OF TENNESSEE

DELTA DENTAL OF TENNESSEE DELTA DENTAL OF TENNESSEE Mission Statement The mission of Delta Dental of Tennessee is to improve oral health by being the leading dental carrier providing programs of demonstrated value that balance

More information

SCHEDULE OF BENEFITS (continued) Group LINK Comprehensive Health Insurance Policy

SCHEDULE OF BENEFITS (continued) Group LINK Comprehensive Health Insurance Policy SCHEDULE OF BENEFITS Classes of Employees Insured: [Class 1 All Active Full-Time Indian Employees] [Monthly Premium Rates: Individual - [$ 398.34] Two-Person [$796.68 ] Family Coverage [$1,210.66]] Benefit

More information

Statement of Understanding

Statement of Understanding Statement of Understanding By signing this application, I represent that all my answers are complete and accurate to the best of my knowledge and belief and that I understand and agree to the following

More information

SCHEDULE OF BENEFITS. Group LINK Comprehensive Health Insurance Policy

SCHEDULE OF BENEFITS. Group LINK Comprehensive Health Insurance Policy SCHEDULE OF BENEFITS Classes of Employees Insured: [Class 1 All Active Full-Time Indian Employees] [Monthly Premium Rates: Individual - [$ 398.34] Two-Person [$796.68] Family Coverage [$1,210.66]] Benefit

More information

2014 Flexible Spending Account Program for Dental & Vision Care And Dependent Care Expenses

2014 Flexible Spending Account Program for Dental & Vision Care And Dependent Care Expenses To: Subject: John Deere Flexible Spending Accounts Participants 2014 Flexible Spending Account Program for Dental & Vision Care And Dependent Care Expenses Dear Participant: Welcome to Group Dynamic, Inc.

More information

Virginia. A guide for individuals and families. The health insurance benefits you want, at a cost you can afford

Virginia. A guide for individuals and families. The health insurance benefits you want, at a cost you can afford Virginia A guide for individuals and families CoventryOne is an individual product (for individuals and families) offered by Coventry Health Care, an Aetna company. The health insurance benefits you want,

More information

BENEFITS ELECTION FORM

BENEFITS ELECTION FORM 2012 SOIDent alandvi s i onpl anopt i ons Benef i t sef f ec t i vemar c h1,2012 ForPa r t i c i pa nt sofs el ec tcompa ni es Table of Contents Welcome Page 2 Introduction Page 2 Who is Eligible? Page

More information

IMPORTANT CARRIER INFORMATION

IMPORTANT CARRIER INFORMATION Anchorage School District Dental Plan Benefits Network: PDP Plus Benefit Summary Coverage Type In-Network Out-of-Network Type A cleanings, oral examinations 100% of Negotiated Fee* 100% of R&C Fee** Type

More information

More to feel good about. Baltimore City Public Schools. 2011 Dental Options

More to feel good about. Baltimore City Public Schools. 2011 Dental Options More to feel good about. Baltimore City Public Schools 2011 Dental Options Baltimore City Public Schools Important Phone Numbers for 2011 DHMO Customer Service (410) 847-9060 or (888) 833-8464 Mailing

More information

HSTA VB Supplemental Group Number 2602

HSTA VB Supplemental Group Number 2602 HSTA VB Supplemental Group Number 2602 Dental Plan Benefits HDS. A plan that puts a smile on your face. This brochure includes a brief description of your HDS dental benefits. All benefits are governed

More information