Page 6 - 2020 Wiese MNS Benefits Guide
P. 6
To Find a Provider DENTAL
Go to deltadentalmo.com Dental Plan—Delta Dental
Click the “Find a Provider” link We partner with Delta Dental of Missouri for our dental carrier. Please
Under Find a Dentist, follow
the link that says “Click see below for a high level plan design and an outline of payroll premiums.
Here to Find A Dental
Care Provider” Service PPO/Premier and Out-of-Network*
Select the Specialty you’re Calendar Year Maximum $1,500
searching for Deductible $50 individual/$150 family
Choose the Delta Dental PPO Preventive Services* 100%
Plus Premier Network Basic Services* 80%
Click on “Find Dentists”
Major Services* 50%
Orthodontics 50%
Lifetime Maximum $1,500
* Out-of-network reimbursements are based upon Delta Dental’s reasonable and customary
charges. You will receive a greater beneit by visiting an in-network provider.
Team Member Cost Per Week
TM Only $2 .25
TM + Spouse $4 .25
TM + Child(ren) $3 .50
TM + Family $5 .50
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Go to deltadentalmo.com Dental Plan—Delta Dental
Click the “Find a Provider” link We partner with Delta Dental of Missouri for our dental carrier. Please
Under Find a Dentist, follow
the link that says “Click see below for a high level plan design and an outline of payroll premiums.
Here to Find A Dental
Care Provider” Service PPO/Premier and Out-of-Network*
Select the Specialty you’re Calendar Year Maximum $1,500
searching for Deductible $50 individual/$150 family
Choose the Delta Dental PPO Preventive Services* 100%
Plus Premier Network Basic Services* 80%
Click on “Find Dentists”
Major Services* 50%
Orthodontics 50%
Lifetime Maximum $1,500
* Out-of-network reimbursements are based upon Delta Dental’s reasonable and customary
charges. You will receive a greater beneit by visiting an in-network provider.
Team Member Cost Per Week
TM Only $2 .25
TM + Spouse $4 .25
TM + Child(ren) $3 .50
TM + Family $5 .50
6
