Berks Member Guide

26 To find a participating dental provider, log in to My Health OnLine and click Find Care. You can also call your Health Care Concierge team for assistance. Dental benefits Make sure to take advantage of all the dental benefits your plan has to offer: 5 • Two oral exams, two cleanings, and one bitewing x-ray per year • One panoramic x-ray every 36 months • Some plans also have a comprehensive dental allowance or standard allowance for fillings and simple tooth extractions Plan Oral exam and cleaning (two per year) One bitewing x-ray per year One panoramic x-ray every 36 months Dental allowance per year HMO Premier Rx (HMO) $0 copay $0 copay $0 copay $150 HMO Rx (HMO) $0 copay $0 copay $0 copay $150 PPO Rx Enhanced (PPO) IN: $15 copay OUT: 50% coinsurance IN: $15 copay OUT: 50% coinsurance IN: $15 copay OUT: 50% coinsurance $1,000 for comprehensive dental services with 50% coinsurance To find a participating vision provider, log in to My Health OnLine and click Find Care. You can also call your Health Care Concierge team for assistance. E Vision benefits You receive a routine vision exam and allowance every one or two years (depending on your plan). • $0 copay for your routine vision exam. • Use your routine vision allowance4 for the cost of eyewear, such as lenses and frames or contact lenses. Plan Routine vision allowance amount HMO Premier Rx (HMO) $100 per year HMO Rx (HMO) $175 every two years PPO Rx Enhanced (PPO) $200 per year