Page 14 - National General 2021 Annual Benefits Enrollment
P. 14
Dental and Vision Plans and Rates
Delta Dental Plan
Vision Services Plan (VSP)
Dental Vision
Select Delta Dental and choose providers from Delta When you elect VSP coverage you have:
Dental PPO or Delta Dental Premier networks. With either
network: Access to the one of the largest panels of eye care
professionals
Out-of-pocket costs are likely to be less when you A nominal $10 copay for an in-network routine exam
choose an in-network dentist Potential payment for out-of-network benefits
Have 100% coverage for periodic oral exams Coverage for frames, lenses, and contacts
Pay an annual deductible—$50 single/$150 family Access to other savings and discounts
Pay 20% of basic covered services
Pay 50% of major covered services
Receive an annual maximum benefit—$1,750/per
person For More Information
Have a lifetime maximum Orthodontics benefit Call 800.877.7195 or visit www.vsp.com
—$1,500/per person (through age 18)
For More Information
Call 800.662.8856 or visit www.deltadentalnc.com
Bi-Weekly Employee Employee
Rates Employee Employee
and
and
(per pay Only Spouse Child(ren) and Family
period)
Delta $14.30 $28.76 $23.81 $40.71
Dental
VSP Vision $3.12 $6.22 $6.66 $10.64
14
Delta Dental Plan
Vision Services Plan (VSP)
Dental Vision
Select Delta Dental and choose providers from Delta When you elect VSP coverage you have:
Dental PPO or Delta Dental Premier networks. With either
network: Access to the one of the largest panels of eye care
professionals
Out-of-pocket costs are likely to be less when you A nominal $10 copay for an in-network routine exam
choose an in-network dentist Potential payment for out-of-network benefits
Have 100% coverage for periodic oral exams Coverage for frames, lenses, and contacts
Pay an annual deductible—$50 single/$150 family Access to other savings and discounts
Pay 20% of basic covered services
Pay 50% of major covered services
Receive an annual maximum benefit—$1,750/per
person For More Information
Have a lifetime maximum Orthodontics benefit Call 800.877.7195 or visit www.vsp.com
—$1,500/per person (through age 18)
For More Information
Call 800.662.8856 or visit www.deltadentalnc.com
Bi-Weekly Employee Employee
Rates Employee Employee
and
and
(per pay Only Spouse Child(ren) and Family
period)
Delta $14.30 $28.76 $23.81 $40.71
Dental
VSP Vision $3.12 $6.22 $6.66 $10.64
14
