City of Nacogdoches 2021 Enrollment Guide
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
DENTAL INSURANCE<br />
CARRIER: BLUE SHIELD BLUE CROSS<br />
● You will pay less out <strong>of</strong> pocket when you choose an in-network provider.<br />
● Locate an in-network provider at www.bcbstx.com.<br />
● Be sure to ask for a pre-treatment estimate.<br />
● Out-<strong>of</strong>-network providers can balance bill, or bill you for the difference between<br />
the provider’s charge and the allowed amount.<br />
ELECTION<br />
MONTHLY EMPLOYEE COST<br />
Employee Only $0.00<br />
Employee & Spouse $30.97<br />
Employee & Child(ren) $40.80<br />
Employee & Family $82.02<br />
CONTRACTING DENTIST<br />
NON-CONTRACTING DENTIST / UCR 90th<br />
Annual Calendar Deductible<br />
(waived for preventive)<br />
$50 per person, $150 per family $50 per person, $150 per family<br />
Annual Maximum $1,000 $1,000<br />
Annual Maximums are combined for preventive, basic, and major services.<br />
Lifetime Orthodontic Max $1,000 $1,000<br />
Orthodontic Coverage is available for dependent children up to age 19.<br />
17
Change language