Page 20 - Ingram Industries 2021 Benefit Guide
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DENTAL PLANS
Ingram offers robust dental plans. To get the most from your coverage, check to make sure your provider
participates in the network before you enroll.
Delta Dental Plan Cigna Dental Plan*
z Annual deductible applies for all services except z Provides you with coverage through a dental HMO
diagnostic and preventive services (DHMO), with no deductibles to pay
z After you meet the deductible, the plan pays a z Plan pays for all diagnostic and most preventive
percentage for each eligible service—you pay the services received from a Cigna DHMO provider
remainder z For basic and major services and orthodontic
z See the provider of your choice. However, you will treatment, you pay a set copayment for each
lower your out-of-pocket costs if you use a dentist procedure, and the plan pays the rest (check the
who is a member of one of the plan’s two networks, K1-09 fee schedule for current costs)
Delta Dental Premier and Delta Dental PPO z All covered services must be obtained from an
approved Cigna DHMO provider or by referral from
that provider. Before receiving treatment check that
your provider is in the DHMO network
* Available when there are in-network providers where you live.
Dental Plan Highlights
Delta Dental Plan Cigna Dental Plan
Any Provider Network Providers Only
Annual Deductible $50 per person, up to $150 per family None
(applies to basic, major, dental implant
and orthodontic services combined)
Diagnostic and Preventive Services Plan pays 100%, no deductible $0 copay
(includes oral exams, routine
cleanings twice a year, fluoride
treatments, X-rays)
Basic Services Plan pays 80% after deductible You pay a set copay for each
(includes tooth extraction, oral procedure listed in the K1-09 fee
surgery, routine fillings, endodontics schedule, then the plan pays 100%
and periodontal treatments)
Major Services Plan pays 50% after deductible You pay a set copay for each
(includes crowns, dentures, partials, procedure listed in the K1-09 fee
implants, and bridges) schedule, then the plan pays 100%
Dental Implants Plan pays 50% after deductible No coverage
(endosteal implants)
Orthodontic Services Plan pays 50% after deductible, up to You pay a set copay for each
(includes orthodontic diagnostic $1,500 per covered person per lifetime procedure listed in the K1-09 fee
and treatment for both adults and schedule, then the plan pays 100%
children)
Benefits the Plan Pays $1,500 per covered person per Unlimited
(not including orthodontics) calendar year (does not apply to
diagnostic and preventive services)
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Ingram offers robust dental plans. To get the most from your coverage, check to make sure your provider
participates in the network before you enroll.
Delta Dental Plan Cigna Dental Plan*
z Annual deductible applies for all services except z Provides you with coverage through a dental HMO
diagnostic and preventive services (DHMO), with no deductibles to pay
z After you meet the deductible, the plan pays a z Plan pays for all diagnostic and most preventive
percentage for each eligible service—you pay the services received from a Cigna DHMO provider
remainder z For basic and major services and orthodontic
z See the provider of your choice. However, you will treatment, you pay a set copayment for each
lower your out-of-pocket costs if you use a dentist procedure, and the plan pays the rest (check the
who is a member of one of the plan’s two networks, K1-09 fee schedule for current costs)
Delta Dental Premier and Delta Dental PPO z All covered services must be obtained from an
approved Cigna DHMO provider or by referral from
that provider. Before receiving treatment check that
your provider is in the DHMO network
* Available when there are in-network providers where you live.
Dental Plan Highlights
Delta Dental Plan Cigna Dental Plan
Any Provider Network Providers Only
Annual Deductible $50 per person, up to $150 per family None
(applies to basic, major, dental implant
and orthodontic services combined)
Diagnostic and Preventive Services Plan pays 100%, no deductible $0 copay
(includes oral exams, routine
cleanings twice a year, fluoride
treatments, X-rays)
Basic Services Plan pays 80% after deductible You pay a set copay for each
(includes tooth extraction, oral procedure listed in the K1-09 fee
surgery, routine fillings, endodontics schedule, then the plan pays 100%
and periodontal treatments)
Major Services Plan pays 50% after deductible You pay a set copay for each
(includes crowns, dentures, partials, procedure listed in the K1-09 fee
implants, and bridges) schedule, then the plan pays 100%
Dental Implants Plan pays 50% after deductible No coverage
(endosteal implants)
Orthodontic Services Plan pays 50% after deductible, up to You pay a set copay for each
(includes orthodontic diagnostic $1,500 per covered person per lifetime procedure listed in the K1-09 fee
and treatment for both adults and schedule, then the plan pays 100%
children)
Benefits the Plan Pays $1,500 per covered person per Unlimited
(not including orthodontics) calendar year (does not apply to
diagnostic and preventive services)
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