DENTAL by ashrafp

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									DENTAL

STATE DENTAL PLAN is available to an employee at no charge. There is a small
monthly premium to cover eligible dependents. An employee must enroll himself
and his dependents within 31 days of his date of hire, within 31 days of a
change in family status or during designated dental enrollment periods (every
two years during the open enrollment period).

Dental Plus provides a higher level of dental coverage at affordable rates for the
same services covered under the State Dental Plan. Dental plus premiums are
paid entirely by the employee with no contribution from the state. Please review
outline and rates below:

                                     State Dental Plan
      Class         Services Covered        Deductibles           Percent       Maximum
                                                                 Covered         Benefit
Class I –          Diagnostic and         None                100% of        $1,000 per
Diagnostic and     preventative                               allowable      person each
Preventative       procedures (x-rays,                        charges        benefit year
                   cleaning and scaling                                      combined for
                   of teeth, fluoride                                        Classes I, II & III.
                   treatments)
Class II – Basic   Fillings, simple       $25 annually        80% of         $1,000 per
                   extractions, oral      combined for        allowable      person each
                   surgery, surgical      Classes II & III,   charges        benefit year
                   extractions            limited to 3 per                   combined for
                                          family per year.                   Classes I, II & III.
Class III –        Onlays, crowns,        $25 annually        50% of         $1,000 per
Prosthetics        bridges, dentures,     combined for        allowable      person each
                   repair of prosthetic   Classes II & III,   charges        benefit year
                   appliances             limited to 3 per                   combined for
                                          family per year.                   Classes I, II & III.
Class IV -         Limited to covered     None                50% of         $1,000 per
Orthodontia        children under age                         allowable      lifetime for each
                   19                                         charges        covered child.



                   2010 DENTAL MONTHLY RATES - EMPLOYEE
                        Basic                      Plus                    Total
Employee Only           0.00                       22.04                  $22.04
Employee/Spouse         7.64                       41.72                  $48.36
Employee/Child          13.72                      45.54                  $59.26
Full Family             21.34                      65.22                  $86.56

								
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