2020 Employee Benefits Book | Page 38

Dental Benefits Renown offers two dental plans to choose from: the Standard and the Enhanced plan. Dental plans are administered by Hometown Health and offer a choice of contracted dentists. Visit HometownHealth.com to find a dentist. Go to “Find a Doctor” and click on the “Diversified Dental” link, or for a current provider list, call Customer Service at 775-982-3232. Benefits Summary Standard Dental Plan Enhanced Dental Plan Calendar Year Deductible $100/person or $300/family $50/person or $150/family Preventive Services (Routine oral exams, cleanings and X-rays) 100% of eligible expenses* (two per calendar year) 100% of eligible expenses* (two per calendar year) Basic Services (Fillings, extractions, oral surgery, etc.) 80% of eligible expenses* after deductible is met 80% of eligible expenses* after deductible is met Major Services (Bridgework, dentures, crowns, etc.) Plan pays 50% of eligible expenses* after deductible is met Plan pays 50% of eligible expenses* after deductible is met Orthodontia 50% coverage for children 18 years and younger up to $1,000 lifetime maximum 50% coverage for children and adults up to $1,500 lifetime maximum Orthodontia Deductible $50 individual deductible in addition to annual deductible $0 Annual Maximum (per covered member) $1,000 $2,000 Dental Plan Rates (Semi-Monthly) Full-Time Employees (36−40/week) Dental Plan Options Employee Only Standard Dental Part-Time Employees (30−35/week Enhanced Dental Dental Plan Options $4.48 $13.78 Employee Only Employee + Spouse $11.90 $34.82 Employee + Children $10.91 Employee + Family $18.21 Standard Dental Enhanced Dental $8.96 $18.94 Employee + Spouse $22.86 $48.75 $31.88 Employee + Children $21.02 $44.59 $52.73 Employee + Family $34.69 $74.14 Part-Time Employees (20−29/week) Dental Plan Options Employee Only 36 Standard Dental $8.90 Employee + Spouse $27.27 Employee + Children $24.84 Employee + Family $42.93 * Eligible expenses are subject to usual and customary fees. For services received from network dentists with Hometown Health, members are not responsible for charges exceeding usual and customary fees. For services obtained from non-network providers, members will be responsible for charges exceeding usual and customary fees.