Page 12 - Guide
P. 12
2017 New Hire Guide
Dental
Note—dental beneit Fontbonne University offers a comprehensive dental plan through Delta
deductions are taken on a pre- Dental.
tax basis. Delta Dental offers two networks: a premier and non-participating dentist
Dental Contributions—Monthly network and a PPO dentist network. You will ind the greatest discounts
Employee only $6.80 with providers who are under the PPO network. Most providers in
Employee + spouse $49.85 the PPO network are also in the premier network because it is a larger
Employee + child(ren) $55.50 network. Note—dentists not in either network are considered non-
Family $73.65 participating providers; this means they can balance bill you and require
you to submit a claim. When seeking treatment with a non-participating
provider you may also experience higher out-of-pocket expenses. It is
Our dental coverage includes always to your advantage to seek treatment with an in-network provider.
Delta’s MAX Advantage. This
very beneicial feature excludes
preventive service charges Please visit deltadentalmo.com to search each network of providers.
(exams, cleanings, etc), from the Delta Dental of Missouri
calendar year maximum.
Premier and Non-
PPO Dentist Participating Dentist
Deductible
Individual $50 $100
Family limit $100 $300
Applies to B & C B & 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%
12
Dental
Note—dental beneit Fontbonne University offers a comprehensive dental plan through Delta
deductions are taken on a pre- Dental.
tax basis. Delta Dental offers two networks: a premier and non-participating dentist
Dental Contributions—Monthly network and a PPO dentist network. You will ind the greatest discounts
Employee only $6.80 with providers who are under the PPO network. Most providers in
Employee + spouse $49.85 the PPO network are also in the premier network because it is a larger
Employee + child(ren) $55.50 network. Note—dentists not in either network are considered non-
Family $73.65 participating providers; this means they can balance bill you and require
you to submit a claim. When seeking treatment with a non-participating
provider you may also experience higher out-of-pocket expenses. It is
Our dental coverage includes always to your advantage to seek treatment with an in-network provider.
Delta’s MAX Advantage. This
very beneicial feature excludes
preventive service charges Please visit deltadentalmo.com to search each network of providers.
(exams, cleanings, etc), from the Delta Dental of Missouri
calendar year maximum.
Premier and Non-
PPO Dentist Participating Dentist
Deductible
Individual $50 $100
Family limit $100 $300
Applies to B & C B & 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%
12
