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    Dental Care 2013 - 2014 FINAL

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    Mattress Firm Benefits
    This document summarizes a dental care plan for associates of Mattress Firm. Associates scheduled to work at least 30 hours per week and have 60 days of continuous service are eligible. Dependents including spouses, common law spouses, and children up to age 26 are also eligible. The plan has a $1,500 annual maximum and $1,000 lifetime orthodontia maximum per child. Preventive care has no deductible while basic and major services have deductibles and coinsurance. Monthly costs for associate-only coverage are $30.41 with costs increasing for family coverage. More details can be found at the listed website or legal documents.

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    Dental Care 2013 - 2014 FINAL

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    Mattress Firm Benefits
    152 views2 pages
    This document summarizes a dental care plan for associates of Mattress Firm. Associates scheduled to work at least 30 hours per week and have 60 days of continuous service are eligible. Dependents including spouses, common law spouses, and children up to age 26 are also eligible. The plan has a $1,500 annual maximum and $1,000 lifetime orthodontia maximum per child. Preventive care has no deductible while basic and major services have deductibles and coinsurance. Monthly costs for associate-only coverage are $30.41 with costs increasing for family coverage. More details can be found at the listed website or legal documents.

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    Dental Care 2013 - 2014 FINAL

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    This document summarizes a dental care plan for associates of Mattress Firm. Associates scheduled to work at least 30 hours per week and have 60 days of continuous service are eligible. Dependents including spouses, common law spouses, and children up to age 26 are also eligible. The plan has a $1,500 annual maximum and $1,000 lifetime orthodontia maximum per child. Preventive care has no deductible while basic and major services have deductibles and coinsurance. Monthly costs for associate-only coverage are $30.41 with costs increasing for family coverage. More details can be found at the listed website or legal documents.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    152 views2 pages

    Dental Care 2013 - 2014 FINAL

    Uploaded by

    Mattress Firm Benefits
    This document summarizes a dental care plan for associates of Mattress Firm. Associates scheduled to work at least 30 hours per week and have 60 days of continuous service are eligible. Dependents including spouses, common law spouses, and children up to age 26 are also eligible. The plan has a $1,500 annual maximum and $1,000 lifetime orthodontia maximum per child. Preventive care has no deductible while basic and major services have deductibles and coinsurance. Monthly costs for associate-only coverage are $30.41 with costs increasing for family coverage. More details can be found at the listed website or legal documents.

    Copyright:

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    2013 2014 Dental Care Plan

    Eligibility Associates who are scheduled to work at least 30 hours per week and have also attained 60 days of continuous service are eligible to participate in the program described below. The effective date of participation will be the 1st of the month following attainment of 60 days of continuous service. Associates scheduled to work less than 30 hours per week and Temporary Associates are ineligible to participate in Mattress Firm benefit plans. Dependents Eligible dependents can enroll in Mattress Firms benefits plans; however, supporting documentation will be required to validate eligibility. Please contact the Benefits Department to determine the required supporting documentation. An eligible dependent includes: 1. 2. 3. 4. Spouse (not fianc, but your legal spouse as determined by applicable law) Common Law Spouse Legal Dependent An Associates child up to age 26 (birth, adoption, or stepchild) Qualified Medical Child Support Order United Healthcare Dental Coverage Plan Provisions Calendar Year Maximum Orthodontia Lifetime maximum (Per Child) Deductible Preventive Care (Exams, Bitewing X-Rays, Other X-Rays, Cleaning & Fluoride, Treatments, Sealants and Palliative Treatment Basic (Fillings, Simple Extractions, Complex Oral Surgery, General Anesthesia, Resin or Amalgam Fillings) Major (Bridges, Dentures, Crowns, Implants) Oral Surgery Orthodontia (Children under 19) $1,500 $1,000 $50 Individual; $150 Family 100% no deductible 80% after deductible 50% after deductible 80% after deductible 50% after deductible

    Additional information and Dental providers may be found at www.myuhcdental.com Monthly Cost to Associates Level of Coverage United HealthCare Dental Associate Only $30.41 Associate and Spouse $55.93 Associate and Child(ren) $59.19 Associate and Family $87.42

    Information contained in this document are summarizations and not intended to replace the full details regarding eligibility, covered expenses, exclusions, limitations, definitions and other provisions of each plan contained in legal documents, handbooks and group contracts. Legal documents shall govern any differences.

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