Page 7 - Guide
P. 7
Dental 2017 Beneits Enrollment
Access to good oral healthcare can help keep your overall health costs down. Regular
oral health exams can help detect signiicant medical conditions before they become
serious. Dental professionals performing checkups can spot symptoms which could
indicate serious health problems elsewhere in the body which need attention.
There are no changes to our dental beneits this year. Dental coverage is offered
through Delta Dental. Please review the additional details provided regarding the
plan design and cost of dental insurance coverage. Keep in mind, the information in
the chart provided is a summary only. Please refer to your summary plan description
(SPD) for complete details of plan beneits, limitations, and exclusions. In the event
of a conlict between the SPD and this description, the terms of the SPD will
prevail.
In-Network Premier Out-of-Network
Deductible/Maximum
Individual Deductible $50 per person $50 per person $50 per person
Family Deductible $150 per family $150 per family $150 per family
Calendar Year Maximum $1,500 $1,500 $1,500
Coinsurance
Preventive Services 100% 100% 100%
(Exams, x-rays, cleanings)
Basic Services 80% 80% 80%
(Fillings, root canals, oral surgery)
Major Services 50% 50% 50%
(Bridges, crowns, dentures)
Orthodontia (Adult and Child Dependents)
Coinsurance 50% 50% 50%
Lifetime Maximum $1,500 $1,500 $1,500
Semi-Monthly Rates
In-Network
Employee Only $4.32
Employee + Spouse $10.76
Employee + Child(ren) $8.26
Employee + Family $15.27
Late Entrant
If you waive coverage and choose to elect dental coverage at a later date, you will be
considered a “late entrant.” This means you will only be able to have preventive services
covered at the amounts listed above for the first 12 months of coverage.
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Access to good oral healthcare can help keep your overall health costs down. Regular
oral health exams can help detect signiicant medical conditions before they become
serious. Dental professionals performing checkups can spot symptoms which could
indicate serious health problems elsewhere in the body which need attention.
There are no changes to our dental beneits this year. Dental coverage is offered
through Delta Dental. Please review the additional details provided regarding the
plan design and cost of dental insurance coverage. Keep in mind, the information in
the chart provided is a summary only. Please refer to your summary plan description
(SPD) for complete details of plan beneits, limitations, and exclusions. In the event
of a conlict between the SPD and this description, the terms of the SPD will
prevail.
In-Network Premier Out-of-Network
Deductible/Maximum
Individual Deductible $50 per person $50 per person $50 per person
Family Deductible $150 per family $150 per family $150 per family
Calendar Year Maximum $1,500 $1,500 $1,500
Coinsurance
Preventive Services 100% 100% 100%
(Exams, x-rays, cleanings)
Basic Services 80% 80% 80%
(Fillings, root canals, oral surgery)
Major Services 50% 50% 50%
(Bridges, crowns, dentures)
Orthodontia (Adult and Child Dependents)
Coinsurance 50% 50% 50%
Lifetime Maximum $1,500 $1,500 $1,500
Semi-Monthly Rates
In-Network
Employee Only $4.32
Employee + Spouse $10.76
Employee + Child(ren) $8.26
Employee + Family $15.27
Late Entrant
If you waive coverage and choose to elect dental coverage at a later date, you will be
considered a “late entrant.” This means you will only be able to have preventive services
covered at the amounts listed above for the first 12 months of coverage.
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