Wyman 2016 Employee Benefits Guide

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2016-2017 Benefits Guide
10
Enhance Your Smile with Dental Coverage
See Clearly with Vision Coverage
Effective December 1, 2016, Sunlife will be
our dental carrier. The benefits are listed
below. To find a provider in your area,
please go to
PPO Benefits
PPO
Network
Out-of -
Network
Deductible
Individual
Family
$50
$150
$50
$150
Coinsurance
Diagnostic/Preventive
Basic Services
Major Services
Orthodontia (Child)
100%
90%
60%
50%
100%
80%
50%
50%
Annual Maximum $1,500/person
Ortho Lifetime Max. $1,000/child
Type of
Coverage
Employee
Bi-Weekly Cost
Employee $1.15
Employee & Spouse $8.08
Employee & Child(ren) $10.18
Employee & Family $15.51
Our vision plan will also be with Sunlife effective
December 1, 2016. If you utilize an out of
network provider, your benefit is based on a
reimbursement schedule. If you are considering
lasik surgery, there is a discount available. Go
to and click
on “Vision” then click on “Search for VSP
Provider” to find a participating provider. You
may also contact Customer Service at 1-800-
786-5433.
Benefits In-Network Out-of-Network
Examination Co-pay $10 Copay $52 Reimbursement
Frequency of Service:
Exam
Lenses
Frames
Every 12 months
Every 12 months
Every 24 months
Lenses
Single
Bifocal
Trifocal
$25 Copay then
100%
100%
100%
Reimbursement
$55
$75
$95
Frames
$25 Co-Pay then
$130 retail allowance
and 20% off balance
$57
Contacts
Necessary
Cosmetic
100%
$130 Allowance
Reimbursement
$250
$105
Type of Coverage
Full Time
Employee
Bi-Weekly Cost
Employee $3.22
Employee + One $6.43
Employee & Children $6.12
Employee & Family $10.51