SMILE! YOU’RE SAVING ON DENTAL COVERAGE Free Preventive Care Keep in mind that both plans offer Just like our medical plans, we offer a choice of dental plans and coverage options so you can pick regular checkups, cleanings, and even just the right combination. And likewise, one option is a traditional, see-any-provider-but-it-might- X-rays at 100% coverage. cost-you plan (the PPO). The other is an HMO-style plan (the “DMO”). This only pays for in-network services, requires that you choose a primary care dentist, and typically costs less overall. Aetna DMO Aetna PPO Annual deductible None $50 employee $150 family Preventive care (exams, cleaning, X-rays) Free Free, deductible waived General care (non-surgical treatment for extractions, See schedule 20% periodontics, endodontics, fillings, anesthetics, etc.) for copay Major care (crowns, inlays, gold fillings, fixed bridgework) See schedule for copay 50% Annual maximum None $2,000 (including orthodontia) Orthodontia (adults and children) See Schedule for benefits 50% up to $2,000 lifetime maximum The details can get complicated, but if you’re into that you’ll find them on Calibrate. Better yet, just call Aetna at 877-238-6200. SEE THE BENEFITS: YOUR VISION PLAN You can also choose a comprehensive vision plan from national leader VSP. Benefits are generally higher when you see a provider in their extensive network — which includes Costco Optical. Most services are available once every 12 months, except as shown. VSP Network Out-of-Network Eye Exam $10 copay $73 allowance Lens: Standard $25 copay $33 allowance Bifocal $25 copay $49 allowance Trifocal $25 copay $65 allowance Frames (once every 24 months, $25 (up to $150 allowance) $25 (up to $68 allowance) instead of contact lenses) Contact Allowance $25 (up to $150 allowance) $25 (up to $135 allowance) Your Cost For Coverage Bi-Weekly Rates Employee Only Employee + Spouse Employee + Child(ren) Family Aetna DMO $3.00 $6.00 $6.00 $15.00 Aetna PPO $8.00 $21.00 $17.00 $38.00 VSP Vision Plan $1.00 $2.00 $2.00 $4.00 11