University of Southern California

Dental

Biweekly employee cost for dental plans (salary reduction–pretax dollars)

	Preventive		Comprehensive
	Full-time	Part-time	Full-time	Part-time
Employee	$2.33	$2.67	$7.74	$8.88
Employee+adult	$4.66	$5.38	$15.49	$17.84
Employee+child	$4.66	$5.38	$15.49	$17.84
Employee+children	$7.55	$8.71	$25.10	$28.92
Employee+adult+child(ren)	$7.55	$8.71	$25.10	$28.92

Dental plans pay a large portion of dental care costs for you and your family. Under the CIGNA Dental plan, you can see any dentist you choose, but you will save money by staying within the network. Full- and part-time staff may choose from two plan options: the lower-cost preventive plan and the higher-cost comprehensive plan.

You pay no deductible under the preventive plan, which provides 100% coverage for in-network preventive care, including oral exams, cleanings, bitewings, full-mouth X-rays and child fluoride treatment. No other dental services are covered.

The comprehensive plan charges no deductible for any of the services provided by the preventive plan, but you pay a $25 in-network deductible and a $50 out-of-network deductible (maximum combined deductible $50) per person for other services. The plan pays 80% after the deductible for basic dentistry (endodontia, periodontia and oral surgery) and 50% after deductible for major work (bridges, dentures, crown replacements and child orthodontia). The annual maximum benefit is $1200 (with a $1000 per-child lifetime orthodontia maximum).

Coverage begins on your 31st day as a benefits-eligible employee provided you have enrolled. For more information, see the CIGNA website or call (800) 244-6224. Brochures are available from Benefits.

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Vision

Biweekly employee cost for Vision Service Plan (salary reduction–pretax dollars)

Employee	$3.81
Employee + adult	$5.28
Employee + child(ren)	$5.38
Employee + adult + child(ren)	$8.67

Through the Vision Service Plan (VSP) you may see any provider, but you can save money by using providers in the VSP network, which includes thousands of optometrists.

If you use a network provider, the plan covers an eye exam every year with a $10 copay. It also covers corrective lenses each year with a $15 copay, and one pair of eyeglass frames every 24 months up to a $170 allowance, plus a 20% discount on any amounts exceeding the retail frame allowance.

If you prefer contact lenses, you may elect to receive a $150 allowance in lieu of frames and lenses once per calendar year. If contacts are medically necessary, you will only pay a $20 copay.

VSP has arranged for members to receive laser eye surgery, using wavefront technology only, at a discounted fee through in-network providers. The maximum fee you will pay is $1500 per eye for PRK, $1800 per eye for LASIK and $2300 per eye for Custom LASIK.

If you choose an out-of-network provider, you are eligible for reimbursement of up to $45 for an annual exam, $45 for single-vision lenses, $65 for lined bifocals, $85 for lined trifocals and $125 for lenticular. Polycarbonate lenses for children are not covered. Frames are reimbursed up to $55, elective contacts are reimbursed up to $150 in lieu of frames and lenses, and medically necessary contacts are reimbursed up to $210. No laser eye surgery is reimbursable if performed by an out-of-network provider.