Page 15 - 2019 Fontbonne
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DENTAL
Please visit www.deltadentalmo.com to search each network of Fontbonne University continues to
providers. offer a comprehensive dental plan
through Delta Dental.
Delta Dental of Missouri
Premier and Non-
PPO Dentist Participating Dentist As in years past, Delta Dental offers
Deductible two networks: a premier and non-
Individual $50 $100 participating dentist network and a
Family limit $100 $300 PPO dentist network. You will ind
Applies to B & C B & C the greatest discounts with providers
Maximums
Calendar year maximum (A, B, and C) $1,500 $1,500 who are under the PPO network. Most
Orthodontic lifetime maximum (D) $1,500 $1,500 providers in the PPO network are
Coinsurance also in the premier network because
Coverage A (preventive) 100% 100% it is a larger network. Note—dentists
Coverage B (basic) 90% 80% not in either network are considered
Coverage C (major) 60% 50%
Coverage D (orthodontic) 50% 50% non-participating providers; this means
they can balance bill you and require
you to submit a claim. When seeking
Note—dental beneit deductions are taken on a pre-tax basis. treatment with a non-participating
Dental Contributions—Monthly provider you may also experience
Employee only $7.75 higher out-of-pocket expenses. It
Employee + spouse $55.00
Employee + child(ren) $61.00 is always to your advantage to seek
Family $81.00 treatment with an in-network provider.
Our dental coverage includes Delta’s MAX Advantage. This very beneicial
feature excludes preventive service charges (exams, cleanings, etc), from
the calendar year maximum.
Fontbonne University 15
15
Please visit www.deltadentalmo.com to search each network of Fontbonne University continues to
providers. offer a comprehensive dental plan
through Delta Dental.
Delta Dental of Missouri
Premier and Non-
PPO Dentist Participating Dentist As in years past, Delta Dental offers
Deductible two networks: a premier and non-
Individual $50 $100 participating dentist network and a
Family limit $100 $300 PPO dentist network. You will ind
Applies to B & C B & C the greatest discounts with providers
Maximums
Calendar year maximum (A, B, and C) $1,500 $1,500 who are under the PPO network. Most
Orthodontic lifetime maximum (D) $1,500 $1,500 providers in the PPO network are
Coinsurance also in the premier network because
Coverage A (preventive) 100% 100% it is a larger network. Note—dentists
Coverage B (basic) 90% 80% not in either network are considered
Coverage C (major) 60% 50%
Coverage D (orthodontic) 50% 50% non-participating providers; this means
they can balance bill you and require
you to submit a claim. When seeking
Note—dental beneit deductions are taken on a pre-tax basis. treatment with a non-participating
Dental Contributions—Monthly provider you may also experience
Employee only $7.75 higher out-of-pocket expenses. It
Employee + spouse $55.00
Employee + child(ren) $61.00 is always to your advantage to seek
Family $81.00 treatment with an in-network provider.
Our dental coverage includes Delta’s MAX Advantage. This very beneicial
feature excludes preventive service charges (exams, cleanings, etc), from
the calendar year maximum.
Fontbonne University 15
15
