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Lincoln Dental Summary - lincoln dental group

Lincoln Dental Summary -lincoln dental group

Full-Time Employees of Gulfport School District
Benefits At-A-Glance
Dental Insurance
In-Network Out-of-Network
The Lincoln Calendar (Annual) Individual: $50 Individual: $50
DentalConnect? PPO Deductible Family: $150 Family: $150
Waived for: Preventive Waived for: Preventive
Plan: Deductibles are combined for basic and major In-Network services.
Covers many preventive, Deductibles are combined for basic and major Out-of-Network services.
basic, and major dental care Annual Maximum $1,000 $1,000
services With SmileRewardsSM, the cost of preventive services is not deducted
from your annual maximum. So more benefit dollars are available for
Also covers orthodontic other important services throughout the year.
treatment for children You and each of your covered family members can receive important
Features group coverage for preventive dental services like exams, cleanings, and x-rays without
worrying about exceeding your annual plan maximum.
Gulfport School District
employees Lifetime $1,000 $1,000
Orthodontic Max
Allows you to choose any Orthodontic Coverage is available for dependent children.
dentist you wish, though you Waiting Period This plan includes a waiting period if you do not
can lower your out-of-pocket enroll when it is first offered to you. (Does not apply
costs by selecting a network if late entry is due to a qualifying family event or
provider Open Enrollment)
0 months for basic services
Does not make you and your 12 months for major services
loved ones wait six months 12 months for orthodontic services
between routine cleanings
The Lincoln National Life Insurance Company
Preventive Services In-Network Out-of-Network
Routine oral exams
Bitewing X-rays
Full-mouth or panoramic X-rays
Other dental X-rays (including periapical films) 100% 100%
Routine cleanings No Deductible No Deductible
Fluoride treatments
Labs & other tests
Basic Services In-Network Out-of-Network
Space maintainers for children
Problem focused exams
Palliative treatment (including emergency relief of dental pain)
Injections of antibiotics and other therapeutic medications
Fillings 90% 80%
Simple extractions After Deductible After Deductible
Surgical extractions
Oral surgery
Biopsy and examination of oral tissue (including brush biopsy)
General anesthesia and I.V. sedation
Prosthetic repair and recementation services
Major Services In-Network Out-of-Network
Prefabricated stainless steel and resin crowns
Endodontics (including root canal treatment)
Periodontal maintenance procedures
Non-surgical periodontal therapy
Periodontal surgery 60% 50%
Bridges After Deductible After Deductible
Full and partial dentures
Denture reline and rebase services
Crowns, inlays, onlays and related services
Orthodontics In-Network Out-of-Network
Orthodontic exams
Extractions 50% (Up to $1,000 50% (Up to $1,000
Study models Lifetime Benefit) Lifetime Benefit)
In-Network/Out-of-Network Dentists In-Network Out-of-Network
... you pay a deductible (if
To find an in-network dentist near you, visit ...you pay a deductible (if applicable), then 50% of the
www.LincolnFinancial.com/FindADentist. applicable), then 40% of usual and customary fee,
the remaining discounted which is the maximum
This plan lets you choose any dentist you wish. However, your fee for PPO members. This expense covered by the plan.
out-of-pocket costs are likely to be lower when you choose an in- is known as a PPO You are responsible for the
network dentist. For example, if you need a crown... contracted fee. difference between the usual
and customary fee and the
dentist's billed charge.
Dental Coverage | At-A-Glance
With the Lincoln Dental Benefit Exclusions
Mobile App Like any coverage, this dental coverage does have some exclusions.
The plan does not cover services started before coverage begins or
Find a network dentist near you in after it ends. Benefits are limited to appropriate and necessary
minutes procedures listed in the summary plan description. Benefits are not
Have an ID card on your phone payable for duplication of services. Covered expenses will not exceed
Customize the app to get details of your the summary plan description's usual and customary allowances.
plan Plan benefits are not payable for a condition that is covered under
Find out how much your plan covers for Workers' Compensation or a similar law; that occurs during the
checkups and other services course of employment or military service or involvement in an illegal
Keep track of your claims occupation, felony, or riot; or that results from a self-inflicted injury.
Lincoln DentalConnect? Online The plan does not cover an orthodontia treatment plan started
Health Center before coverage begins unless the member was receiving
orthodontia benefits from the employer's previous group dental
Determine the average cost of a dental summary plan description. In this case, Lincoln Financial will continue
procedure orthodontia benefits until the combined benefit paid by both policies
Have your questions answered by a is equal to this summary plan description's lifetime orthodontia
licensed dentist maximum. Plan benefits are not payable if the orthodontic appliance
Learn all about dental health for children, was installed after the age of 19.
from baby's first tooth to dental In certain situations, there may be more than one method of treating
emergencies a dental condition. This summary plan description includes an
Evaluate your risk for oral cancer, alternative benefits provision that may reduce benefits to the lowest-
periodontal disease and tooth decay cost, generally effective, and necessary form of treatment.
Covered Family Members Certain conditions, such as age and frequency limitations, may
impact your coverage. See the summary plan description for details.
When you choose coverage for yourself, you This plan includes continuation of coverage for employees with
can also provide coverage for: dental coverage from a previous employer. The member is required
? Your spouse. to complete the Continuity of Coverage form located on
? Dependent children, up to age 26. www.lfg.com. The form must be provided to us prior to the effective
date to be eligible for continuation of coverage.
A complete list of benefit exclusions is included in the summary plan
Questions? Call 800-423-2765 and mention Group ID: GULFPORTSC.
This is not intended as a complete description of the coverage offered. Controlling provisions are provided in the summary plan description, and
this summary does not modify coverage. A summary plan description will be made available to you that describes the benefits in greater detail.
Refer to your summary plan description for your maximum benefit amounts.
Lincoln DentalConnect? health center Web content is provided by go2dental.com, Santa Clara, CA. Go2dental.com is not a Lincoln Financial Group?
company. Coverage is subject to actual summary plan description language. Each independent company is solely responsible for its own
The Lincoln National Life Insurance Company (Fort Wayne, IN), does not conduct business in New York, nor is it licensed to do so. In New York,
business is conducted by Lincoln Life & Annuity Company of New York (Syracuse NY). Both are Lincoln Financial Group Companies.
?2019 Lincoln National Corporation LCN-2012491-013118 R 1.0 - Group ID: GULFPORTSC
Dental Coverage | At-A-Glance