Page 16 - Fontbonne New Hire
P. 16
Note—dental beneit Dental
deductions are taken on a pre- Fontbonne University offers a comprehensive dental plan through Delta
tax basis. Dental.
Dental Contributions—Monthly
Employee only $7.25 Delta Dental offers two networks: a premier and non-participating dentist
Employee + spouse $53.00 network and a PPO dentist network. You will ind the greatest discounts
Employee + child(ren) $59.00 with providers who are under the PPO network. Most providers in
Family $77.50 the PPO network are also in the premier network because it is a larger
network. Note—dentists not in either network are considered non-
Our dental coverage includes Delta’s participating providers; this means they can balance bill you and require
MAX Advantage. This very beneicial you to submit a claim. When seeking treatment with a non-participating
feature excludes preventive service provider you may also experience higher out-of-pocket expenses. It is
charges (exams, cleanings, etc) from always to your advantage to seek treatment with an in-network provider.
the calendar year maximum.
Please visit deltadentalmo.com to search each network of providers.
Delta Dental of Missouri
Premier and Non-
PPO Dentist Participating Dentist
Deductible
Individual $50 $100
Family limit $100 $300
Applies to B and C B and C
Maximums
Calendar year maximum (A, B, and C) $1,500 $1,500
Orthodontic lifetime maximum (D) $1,500 $1,500
Coinsurance
Coverage A (preventive) 100% 100%
Coverage B (basic) 90% 80%
Coverage C (major) 60% 50%
Coverage D (orthodontic) 50% 50%
16 2018 New Hire Enrollment
deductions are taken on a pre- Fontbonne University offers a comprehensive dental plan through Delta
tax basis. Dental.
Dental Contributions—Monthly
Employee only $7.25 Delta Dental offers two networks: a premier and non-participating dentist
Employee + spouse $53.00 network and a PPO dentist network. You will ind the greatest discounts
Employee + child(ren) $59.00 with providers who are under the PPO network. Most providers in
Family $77.50 the PPO network are also in the premier network because it is a larger
network. Note—dentists not in either network are considered non-
Our dental coverage includes Delta’s participating providers; this means they can balance bill you and require
MAX Advantage. This very beneicial you to submit a claim. When seeking treatment with a non-participating
feature excludes preventive service provider you may also experience higher out-of-pocket expenses. It is
charges (exams, cleanings, etc) from always to your advantage to seek treatment with an in-network provider.
the calendar year maximum.
Please visit deltadentalmo.com to search each network of providers.
Delta Dental of Missouri
Premier and Non-
PPO Dentist Participating Dentist
Deductible
Individual $50 $100
Family limit $100 $300
Applies to B and C B and C
Maximums
Calendar year maximum (A, B, and C) $1,500 $1,500
Orthodontic lifetime maximum (D) $1,500 $1,500
Coinsurance
Coverage A (preventive) 100% 100%
Coverage B (basic) 90% 80%
Coverage C (major) 60% 50%
Coverage D (orthodontic) 50% 50%
16 2018 New Hire Enrollment
