Page 19 - AESC 2019 Benefits Gudie
P. 19
Dental Find an In-Network
Dental Benefits Provider
Remember to visit dentists in
Access to good oral healthcare is important to your overall health. This Delta’s largest network (Delta
is why Envision AESC offers dental insurance as a core part of your Dental PPO) to receive the
beneits package. We partner with Delta Dental of Tennessee to offer you deepest level of discounts on
and your family members dental insurance. Visit www.deltadentaltn.com your services . Delta PPO dentists
have agreed to provide discounts
to ind in-network providers and access a variety of online tools and from 20% to 30%; Delta Premier
programs and print extra ID cards. from 5% to 10% . Out-of-network
dentists will be reimbursed at
Dental Contributions Delta Dental’s maximum allowable
charge which is equivalent to
2019 Dental Plan Pre-tax Premiums Per Month* the 51st percentile of usual and
Employee Only $5 customary fees and may balance
Employee + Spouse $10 bill you for the difference between
Employee + Child(ren) $10 billed and allowed charges . To
Family $17 find a participating in-network
dentist in your area go to
* If you do not enroll in or waive dental coverage during your 30-day enrollment deltadentaltn.com .
period, you will be automatically enrolled for employee only coverage in the dental
plan on your 31st day of employment .
Orthodontia Services
The lifetime maximum illustrated
is different from the calendar
year maximum . For orthodontia
services, this limit does not reset
each year . This is the most your
plan will cover for orthodontia
services for the lifetime of your
participation in this program .
Examples of Services
X Preventive—exams, cleanings,
fluoride, and x-rays
X Basic—fillings, sealants,
extractions, periodontics,
repairs, and oral surgery
X Major—crowns, inlays,
dentures, and dental impacts
Envision AESC 19
Dental Benefits Provider
Remember to visit dentists in
Access to good oral healthcare is important to your overall health. This Delta’s largest network (Delta
is why Envision AESC offers dental insurance as a core part of your Dental PPO) to receive the
beneits package. We partner with Delta Dental of Tennessee to offer you deepest level of discounts on
and your family members dental insurance. Visit www.deltadentaltn.com your services . Delta PPO dentists
have agreed to provide discounts
to ind in-network providers and access a variety of online tools and from 20% to 30%; Delta Premier
programs and print extra ID cards. from 5% to 10% . Out-of-network
dentists will be reimbursed at
Dental Contributions Delta Dental’s maximum allowable
charge which is equivalent to
2019 Dental Plan Pre-tax Premiums Per Month* the 51st percentile of usual and
Employee Only $5 customary fees and may balance
Employee + Spouse $10 bill you for the difference between
Employee + Child(ren) $10 billed and allowed charges . To
Family $17 find a participating in-network
dentist in your area go to
* If you do not enroll in or waive dental coverage during your 30-day enrollment deltadentaltn.com .
period, you will be automatically enrolled for employee only coverage in the dental
plan on your 31st day of employment .
Orthodontia Services
The lifetime maximum illustrated
is different from the calendar
year maximum . For orthodontia
services, this limit does not reset
each year . This is the most your
plan will cover for orthodontia
services for the lifetime of your
participation in this program .
Examples of Services
X Preventive—exams, cleanings,
fluoride, and x-rays
X Basic—fillings, sealants,
extractions, periodontics,
repairs, and oral surgery
X Major—crowns, inlays,
dentures, and dental impacts
Envision AESC 19
