2016 PfP Employee Memo

6 / 13

Places for People, Inc. 2016 Annual Enrollment
2016 Page 6
Voluntary Dental Plan Summary
Places for People will move to Lincoln effective January 1, 2016. The benefits in and out of network did not change; and
the benefits also include a Max Rollover feature. Below is a reminder of the dental plan features.
2016 Employee Dental Contributions
Dental Employee Cost Monthly
Employee $22.67
Employee & Spouse $44.94
Employee & Child(ren) $48.93
Employee & Family $74.99
To find a Lincoln provider in your area, visit the website
at
 Scroll to the bottom of the webpage
 Click on “Find a Dentist” under Employer Benefits
 Enter your Zip Code
 Click on Search
A provider directory will be created on the next screen
showing the providers that are closest to the zip code
you entered.
Guardian In Network
PPO
Out of Network
Providers
Calendar Year
Deductible
 Applied to Basic and Major services
$50 individual
$150 family
$50 individual
$150 family
Annual
Maximum
 Applied to Preventive, Basic and Major services $1,000 $1,000
Preventive
Services
 Cleanings
 X-rays
 Fluoride Treatments
 Sealants
 Space Maintainers
100% 80%
Basic
Services
 Fillings
 Simple Extractions
 General Services
 Periodontics
 Endodontics
80% 70%
Major
Services
 Oral Surgery
 Crowns
 Dentures
50% 40%
Orthodontia  For children to age 19 only
50% to $1,000
lifetime max
50% to $1,000
lifetime max
Max Rollover
 Rollover Threshold
 Rollover Amount
 Rollover In-network Amount
 Rollover Account Limit
$500
$250
$350
$1,000