Page 14 - Brady Corporation 2021 Annual Benefits Florida
P. 14
2021
Dental
We partner with Delta Dental to ofer you the option between two dental plans—choose the plan that’s right
for you.
Gold Plan Silver Plan
PPO Premier Out-of-Network PPO Premier Out-of-Network
Deductible— $35/$70 $50/$100 $50/$100 $35/$70 $50/$100 $50/$100
Individual/Family
Annual Maximum $1,500 $1,500 $1,500 $1,000 $1,000 $1,000
Preventive 100% 100%* 100%* 100% 100%* 100%*
Basic 80%* 80%* 80%* 80%* 60%* 60%*
Oral Surgery** 80%* 80%* 80%* 80%* 80%* 80%*
Major 50%* 50%* 50%* 50%* 40%* 40%*
Orthodontia
Coinsurance 50% 50% 50% None None None
Lifetime Maximum $1,500 $1,500 $1,500 None None None
Coverage Notes
Dependent Eligibility Dependents are covered to the end of the month Dependents are covered to the end of the month
during which they turn 26. during which they turn 26.
CheckUp Plus Yes Yes
EBICP
*Deductible applies.
**Oral surgery has a separate $3,000 annual maximum. TMJ has a separate $1,000 lifetime maximum.
Employee Monthly Dental CheckUp Plus allows enrollees in both plans to
TM
Contributions get diagnostic and preventive dental services without
those costs getting applied to the individual annual
Gold Plan Silver Plan maximum—leaving more lexibility for restorative care
Employee Only $25.00 $14.00 that might be needed later.
Employee and Spouse $52.00 $29.00
Employee and Child(ren) $45.00 $25.00 Evidence-Based Integrated Care Plan (EBICP)
Family $74.00 $41.00
provides additional cleaning(s) and/or luoride
treatments to individuals in both plans with speciic
Examples of Services medical conditions that have oral implications.
Preventive—exams, cleanings, luoride, x-rays,
and sealants This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
Basic—illings, extractions, periodontics, repairs, and there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.
oral surgery
Major—crowns, inlays, dentures, and dental impacts
Orthodontia Services Note Finding Information About Your
Dental Coverage
The lifetime maximum illustrated is diferent from the
calendar year maximum. For orthodontia services, this limit Visit www.deltadentalwi.com to ind in-network
does not reset each year. This is the most your plan will providers and access a variety of online tools
cover for your services for the lifetime of your participation in and programs.
this program.
14
Dental
We partner with Delta Dental to ofer you the option between two dental plans—choose the plan that’s right
for you.
Gold Plan Silver Plan
PPO Premier Out-of-Network PPO Premier Out-of-Network
Deductible— $35/$70 $50/$100 $50/$100 $35/$70 $50/$100 $50/$100
Individual/Family
Annual Maximum $1,500 $1,500 $1,500 $1,000 $1,000 $1,000
Preventive 100% 100%* 100%* 100% 100%* 100%*
Basic 80%* 80%* 80%* 80%* 60%* 60%*
Oral Surgery** 80%* 80%* 80%* 80%* 80%* 80%*
Major 50%* 50%* 50%* 50%* 40%* 40%*
Orthodontia
Coinsurance 50% 50% 50% None None None
Lifetime Maximum $1,500 $1,500 $1,500 None None None
Coverage Notes
Dependent Eligibility Dependents are covered to the end of the month Dependents are covered to the end of the month
during which they turn 26. during which they turn 26.
CheckUp Plus Yes Yes
EBICP
*Deductible applies.
**Oral surgery has a separate $3,000 annual maximum. TMJ has a separate $1,000 lifetime maximum.
Employee Monthly Dental CheckUp Plus allows enrollees in both plans to
TM
Contributions get diagnostic and preventive dental services without
those costs getting applied to the individual annual
Gold Plan Silver Plan maximum—leaving more lexibility for restorative care
Employee Only $25.00 $14.00 that might be needed later.
Employee and Spouse $52.00 $29.00
Employee and Child(ren) $45.00 $25.00 Evidence-Based Integrated Care Plan (EBICP)
Family $74.00 $41.00
provides additional cleaning(s) and/or luoride
treatments to individuals in both plans with speciic
Examples of Services medical conditions that have oral implications.
Preventive—exams, cleanings, luoride, x-rays,
and sealants This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
Basic—illings, extractions, periodontics, repairs, and there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.
oral surgery
Major—crowns, inlays, dentures, and dental impacts
Orthodontia Services Note Finding Information About Your
Dental Coverage
The lifetime maximum illustrated is diferent from the
calendar year maximum. For orthodontia services, this limit Visit www.deltadentalwi.com to ind in-network
does not reset each year. This is the most your plan will providers and access a variety of online tools
cover for your services for the lifetime of your participation in and programs.
this program.
14
