Page 14 - Yaskawa Motoman Robotics 2022 Benefits Guide
P. 14
Dental
Delta Dental PPO Plan
Yaskawa Motoman Robotics will continue ofering dental insurance through Delta Dental of IL. This PPO
dental program provides eligible Employees easy access to a national network of dental providers consisting
of general and specialty dentists who meet well-established credentialing standards. Beneits are based on
negotiated fees, and participating dentists agree to accept negotiated fees.
To view a listing of providers, covered services, status of a claim, deductible balance, and oral health and
wellness information, go to www.DeltaDentalil.com.
Low Plan High Plan
®
®
Delta Dental PPO PPO Network Premier Non-Network PPO Network Premier Non-Network
Dentist Network Dentist Dentist Network Dentist
Dentist Dentist
Deductible
Individual $50 $50
Family $150 $150
Diagnostic and Preventative: 100% 100%
Basic Services: 60% 80%
Major Services: 50% 50%
Annual Maximum $1,000/person $1,000/person
Orthodontic Services: 50% up to age 19 50% up to age 19
Lifetime Maximum $1,000/dependent $1,000/dependent
Bi-Weekly Employee Contributions
Low Plan High Plan
Employee $5.40 $7.78
Employee + Spouse $10.24 $14.48
Family $18.51 $25.56
* Note 26 annual pay periods
14
Delta Dental PPO Plan
Yaskawa Motoman Robotics will continue ofering dental insurance through Delta Dental of IL. This PPO
dental program provides eligible Employees easy access to a national network of dental providers consisting
of general and specialty dentists who meet well-established credentialing standards. Beneits are based on
negotiated fees, and participating dentists agree to accept negotiated fees.
To view a listing of providers, covered services, status of a claim, deductible balance, and oral health and
wellness information, go to www.DeltaDentalil.com.
Low Plan High Plan
®
®
Delta Dental PPO PPO Network Premier Non-Network PPO Network Premier Non-Network
Dentist Network Dentist Dentist Network Dentist
Dentist Dentist
Deductible
Individual $50 $50
Family $150 $150
Diagnostic and Preventative: 100% 100%
Basic Services: 60% 80%
Major Services: 50% 50%
Annual Maximum $1,000/person $1,000/person
Orthodontic Services: 50% up to age 19 50% up to age 19
Lifetime Maximum $1,000/dependent $1,000/dependent
Bi-Weekly Employee Contributions
Low Plan High Plan
Employee $5.40 $7.78
Employee + Spouse $10.24 $14.48
Family $18.51 $25.56
* Note 26 annual pay periods
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