DENTAL BENEFITS

Good dental care is key to your overall health and wellness. Reimbursement for dental services is based on your choice of in-network or out-of-network provider and reasonable and customary charges (R&C) in your local area.

The dental plan covers three main types of expenses: preventive and diagnostic services like routine exams and cleanings, fluoride treatments, sealants and x-rays; basic services such as simple fillings, stainless steel crowns and gum disease treatment; and major services like endodontics, dentures, dental implants, root canals and oral surgery.

Dental ID cards will be mailed to you. You also have the option to print one from the member secure website, or pull it up on the Aetna App just like you can for your Medical ID card.

Key Features	PPO Plan In-Network	PPO Plan Out-of-Network
Individual Deductible	$50	$50
Family Deductible	$150	$150
Preventive Coinsurance	100%	100% of R&C fee
Basic Coinsurance	80%	60% of R&C fee
Major Coinsurance	50%	50% of R&C fee
Annual Plan Maximum	$2,000	$2,000
Orthodontia Coinsurance	50%	50% of R&C fee
Orthodontia Lifetime Maximum	$1,000	$1,000

Your Cost Per Pay Period

Tier	You Pay
Employee Only	$7.86
Employee + Spouse	$15.54
Employee + Child(ren)	$18.24
Family	$28.62

VISION BENEFITS

The Vision insurance plan provides reimbursement for eye exams, glasses, and contact lenses. Using in-network providers also gives you access to discounts for things like LASIK surgery and a second pair of frames. You can save money by utilizing in-network vision providers. For a complete list of in-network providers near you, visit www.vsp.com or call 800.877.7195.

For more information surrounding your Vision plan, visit www.veritext.vspforme.com.

Vision ID cards are not printed or mailed after enrollment, however, coverage can be confirmed with your provider by using primary insured DOB and SSN.

Key Features	In-Network Member Cost	Out-of-Network Reimbursement
Exam and Glasses	You pay $20	Up to $45
Frames	Base Plan: $0 copay, $130 allowance, 20% off balance over $130 Buy-Up Plan: $0 copay, $200 allowance, 20% off balance over $200	Up to $70
Standard Plastic Lenses: Single/Bifocal/Trifocal/Lenticular Standard Progressive/Premium Progressive	Included in materials copay $55/$95 to $105	Up to: $30/$50/$65/$65 Up to: $50/$50
Lens Options	Various Lens Enhancements: 20% off retail Standard Contact Lens Fit & Follow Up): You pay $60, paid-in-full and follow-up visits	N/A
Contact Lenses (allowance includes materials only)	Conventional: You pay $0, $130 allowance Laser Vision Correction: 15% off retail or 5% off promotional price	Conventional: Up to $105 Laser Vision Correction: 15% off retail or 5% off promotional price