Dental Insurance
EMPLOYEE BENEFITS
Lincoln Financial Group ABOUT DENTAL Dental insurance is a coverage that helps defray the costs of dental care. It insures against the expense of routine care, dental treatment and disease.
For full plan details, please visit your benefit website: www.mybenefitshub.com/goosecreekcisd
Our dental plan helps you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Premium contributions are deducted from your paycheck on a pretax basis. Coverage is provided through Lincoln Financial Group.
Schedule of Benefits Low Plan
Plan Deductible (Annually on a Plan Year Basis) Individual Family Deductible applies to: Benefit Levels Type 1 – Diagnostic & Preventative Type 2 – Basic Services Type 3 – Major Services Type 4 – Orthodontic Services Benefits Based On Maximum Benefit (per covered person): Types 1, 2 & 3 combined Type 4, while covered by the plan Benefit Waiting Period Type 2 Expenses Type 3 Expenses Type 4 Expenses Late Entrant Limitation Type 2 Expenses Type 3 Expenses Type 4 Expenses
DPPO Plan Two levels of benefits are available with the DPPO plan: in-network and out-of-network. You may select the dental provider of your choice, but your level of coverage may vary based on the provider you see for services. You could pay more if you use an out-of-network provider. High Plan
Contracted Dentist
Non Contracted Dentist
Contracted Dentist
Non Contracted Dentist
$50 $150 Type 2 & 3
$50 $150 Type 2 & 3
$50 $150 Type 2 & 3
$50 $150 Type 2 & 3
100% 50% 50% Negotiated Fees
100% 50% 50% U&C
100% 80% 50% 50% Negotiated Fees
100% 80% 50% 50% U&C
$750 Per Plan Year -
$750 Per Plan Year -
$1,500 Per Plan Year $1,000 Lifetime
$1,500 Per Plan Year $1,000 Lifetime
None None None
None None None
None None None
None None None
DHMO Plan If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the DHMO network directory to manage your care. Each eligible dependent may choose their own PCD. Dental services are unlimited, you pay fixed copays, there are no deductibles and there are no claim forms to file. There is no coverage for services provided without a referral from your PCD or if you seek care from out-of -network providers.
Dental LOW Employee Only $19.70 Employee and Spouse $36.76 Employee and Child(ren) $42.90 Employee and Family $50.32
HIGH $28.30 $54.12 $69.48 $80.90
DHMO $12.60 $24.60 $26.60 $38.44
Questions about your plan or claims? Call or email us. 800-423-2765 Monday – Thursday, 8 a.m. – 8 p.m. ET; Friday, 8 a.m. – 6 p.m. ET Claims@LFG.com 17
