2024 Benefits Booklet

Dental

TABLE OF CONTENTS WELCOME..............................2 WHAT’S NEW........................3 HOW TO ENROLL......... 4-5 MEDICAL......................... 6-13 PRESCRIPTION DRUG.............................. 14-15 ADDITIONAL MEDICAL PLAN RESOURCES............... 16-18 DENTAL......................... 19-20 VISION....................................21 LIFECENTER........................22 LIFE INSURANCE.............23 DISABILITY..........................24 VOLUNTARY OFFERINGS................. 25-28 SPENDING ACCOUNTS.........................29 RETIREMENT BENEFITS..............................30 CONTACTS.................. 31-32

Dental Plan Options AtlantiCare offers the choice of two dental plans, Basic or Plus Ortho, both through Horizon Dental. Coverage highlights include implants, composite resin and orthodontia coverage for adults and children. The Horizon Dental Option Plan gives you the freedom to receive services from any dentist, so no matter which dentist you choose, you save money. When you understand your plan, you can get the most from your dental benefits. Contact Horizon Dental at 1-800-433-6825 or www.horizonblue.com/dental .

Summary of Dental Benefits

Dental Plus Ortho Plan*

Summary of Services

Basic Dental Plan

Preventive (routine exams, xrays, cleanings)

100%

100%

Basic Care (fillings, extractions, periodontal)

70%

90%

Major Care ( crowns, dental implants, dentures)

50%

60%

50% $1,000 annual maximum

60% $1,500 annual maximum 60% $2,000 lifetime maximum

Implants, subject to annual maximum per patient

Orthodontics* subject to a lifetime maximum per person

0%

Annual Maximum Per Individual

$1,500

$2,500

Annual Deductible Amount Per Person

$25

$25

Annual Deductible Amount Per Family

$75

$75

*Orthodontia coverage is only available if enrolled in the plan prior to the initial orthodontia appointment for braces. *You must continue to be enrolled in the“Dental Plus Ortho”plan for the entire time of orthodontia services as payments are on a pro-rated basis.

Bi-Weekly & Annualized Employee Dental Cost

Bi-Weekly Cost

Bi-Weekly Cost

To learn more about your Wellness Benefits scan here:

Coverage Type

For Basic

For Plus Ortho

Employee

$2.60

$9.36

Employee/Child or Employee + Spouse

$5.20

$22.88

Family

$7.80

$26.00

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