Page 16 - Intertek 2022 Benefits Guide
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Dental
Dental Coverage with Delta
Dental
Choose a Delta Dental PPO dentist to ensure you
receive the deepest discounts. Choose a Delta Premier
dentist and receive discounts, although they may not
be as deep as the PPO network. If you receive care
outside of Delta’s PPO or Premier network you will
likely pay a greater amount for dental care and the
provider may balance bill you.
To ind a Delta Dental network provider in your area go
to deltadentalins.com or call 800.521.2651.
Delta Out-of-
Network Network
Deductible/Maximum
Individual deductible $50 $50
Family deductible $150 $150
Calendar year maximum $1,500 $1,500
Coinsurance
Preventive services 100% no 100% no
(Exams, x-rays, cleanings) deductible deductible
Basic services 80% after 80% after
(Fillings, root canals, oral deductible deductible
surgery)
Major services 50% after 50% after
(Bridges, crowns, dentures) deductible deductible
Orthodontia
Coinsurance 50% 50%
Lifetime maximum $1,500 $1,500
Dependent children to age
Eligibility
26
Your cost of coverage is summarized when you enroll
online through https://my.adp.com.
16
Dental Coverage with Delta
Dental
Choose a Delta Dental PPO dentist to ensure you
receive the deepest discounts. Choose a Delta Premier
dentist and receive discounts, although they may not
be as deep as the PPO network. If you receive care
outside of Delta’s PPO or Premier network you will
likely pay a greater amount for dental care and the
provider may balance bill you.
To ind a Delta Dental network provider in your area go
to deltadentalins.com or call 800.521.2651.
Delta Out-of-
Network Network
Deductible/Maximum
Individual deductible $50 $50
Family deductible $150 $150
Calendar year maximum $1,500 $1,500
Coinsurance
Preventive services 100% no 100% no
(Exams, x-rays, cleanings) deductible deductible
Basic services 80% after 80% after
(Fillings, root canals, oral deductible deductible
surgery)
Major services 50% after 50% after
(Bridges, crowns, dentures) deductible deductible
Orthodontia
Coinsurance 50% 50%
Lifetime maximum $1,500 $1,500
Dependent children to age
Eligibility
26
Your cost of coverage is summarized when you enroll
online through https://my.adp.com.
16
