Dwellworks 2023 Benefits Guide

DENTAL – Lincoln COVERAGE OVERVIEW

You have the freedom to select the dentist of your choice; however, when you visit a participating in-network dentist, you will have lower out-of-pocket costs, no balance billing, and claims will be submitted by your dentist on your behalf.

PLAN FEATURES

In-Network

Out of Network

Dentist who are not part of the DentalGuard Network

Dentists who participant in the DentalConnect PPO Network

Network Details

Calendar Year

Benefit Period

DEDUCTIBLE

$50 In-network

Single

$150 In-network

Family

When receiving Basic and Major services (Does not apply for Preventive services)

When does it apply?

COVERED SERVICES

CLASS I: Preventive Services Routine oral exams and cleanings, x-rays (bitewing), sealants & fluoride treatments, space maintainers. CLASS II: Basic Services Periodontics (surgical & non-surgical), endodontics (root canals), oral surgery, fillings, prosthetic maintenance & x-rays (full mouth) CLASS III: Major Services Prosthodontics, crowns, inlays/onlays, dentures, implants & bridges

Covered at 100%

Covered at 100% of Usual and Customary

Covered at 100%

Covered at 80% of Usual and Customary

Covered at 60%

Covered at 50% of Usual and Customary

Ortho Lifetime Maximum - $1,000

Covered at 50%

Covered at 50% of Usual and Customary

PREVENTION FIRST! Your dental health is an important part of your overall health. Make sure you take advantage of your preventive dental visits. Preventive care services are covered at 100% if you visit an In-Network provider. They are also not subject to the annual deductible.

ANNUAL MAXIMUM

Maximum Benefit Allowed per Benefit Period

$1,500

$1,000

Employee Portion (Per pay)

Contributions (24 pays/year) Dental 2023

Dwellworks Portion (Per pay)

Employee

$0.87

$15.63

Employee + Spouse Employee + Child(ren)

$10.75 $13.90 $19.43

$23.30 $30.16 $42.18

Family

How do I find an In-Network Provider? To find an in-network dentist near you, visit www.LincolnFinancial.com/FindADentist This plan lets you choose any dentist you wish. However, your out-of-pocket costs are likely to be lower when you choose an in-network dentist.

| BENEFITS GUIDE

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