Large Group Riders
The following optional riders are available as indicated on the Large Group Comparison
of Benefits. Each description is a brief summary of benefits only and does not constitute a contract. Additional benefit
structures are also available. Please contact your broker or your KPS Account Executive for complete information.
A variety of prescription drug options are available according to your needs. Including,
a three-tier option for generic (Tier 1), preferred brand (Tier 2) and non-preferred brand (Tier 3). You choose the copay amount for each tier.
You can also choose a percentage amount for each tier with minimums and maximums. In addition, you can
also choose to include a deductible for any or all plan options.
$10/$20/$40 (Tier 1/Tier 2/Tier 3)
$10/$30/50% with $35 minimum (Tier 1/Tier 2/Tier 3)
Occupational Injury Rider
Treatment of work-related illnesses and injuries is covered to the extent the service or procedure is included as a covered
service or benefit in the Benefits Booklet. This benefit is limited to $250,000 per lifetime.
Limitations: Occupational Injury coverage applies only to those enrollees who are not required by law to
participate in a Worker's Compensation insurance program. The rider covers ONLY owners and officers who are
enrolled in the plan as employees. Employees must work the minimum number of hours specified by the group in the
Group Master Application.
Large Group Overview
The following benefits are paid at 100% of the KPS Fee Schedule
(For details, refer to the Schedule of Dental procedures)
Class 1 (no deductible): Examinations, X-rays, cleaning, fluoride treatments
Class 2: Restoration through fillings, oral surgery, periodontics,
Class 3: Bridges, partials, dentures, crowns, inlays
Deductibles & Maximum Benefits (on Class II & III services)
Limitations (per person per calendar year)
One oral examination and prophylaxis twice per year
One fluoride treatment twice per year to age 18
Supplemental bite-wing X-rays twice per year
One panorex X-ray every three calendar years
This is an indemnity benefit. You can go to any licensed dental provider. Reimbursement will be limited to the KPS Fee Schedule. (For details, refer to the Schedule of Dental Procedures)
There is a 12-month waiting period for Class III services
This rider is available with three benefit levels on large group plans. Each plan offers no deductibles and no copays.
One routine eye examination each calendar year paid at 100% for participating providers and
60% for non-participating providers.
Eyeglass frames and lenses (any type), hard/soft contact lenses and lens options, such as tinting, are covered as follows:
Vision 100: 100% up to a maximum payment of $100 per calendar year
Vision 200: 80% up to a maximum payment of $200 per calendar year
Vision 300: 80% up to a maximum payment of $300 per calendar year
Limitations: All limitations and exclusions defined in the Benefits Booklet apply to this Vision Rider.