Page 8 - 2020 NextCare Enrollment
P. 8
Example Services DENTAL
Preventive—oral NextCare offers dental insurance through Delta Dental of Arizona. Delta
Examinations, prophylaxis, Dental has a unique two-tiered network of PPO and Premier providers
bitewing x-rays, x-rays, topical
luoride applications, sealants, meaning a large network of options for your dental care.
and space maintainers
Basic—illings, injections of Providers in these networks will never “balance bill” participants or
antibiotic drugs, extractions, charge more than the agreed upon rates for services. Discounts may be
emergency palliative
treatment, anesthesia, deeper in the PPO network versus the Premier network. Talk to your
consultations, repairs, relining dentist about how they participate.
and rebasing, endodontics,
periodontics, and oral surgery An ID card will be mailed to you after enrollment. Visit
Major—crowns, inlays, on www.deltadentalaz.com to ind network providers, manage your claims,
lays, bridges, and dentures
and learn more about your dental care.
Balance Billing In-Network
Participating providers have agreed Deductible $50 individual
to speciic prices for procedures $150 family
in our plan . When you visit non-
participating providers, your cost Calendar Year Maximum $1,500 per member
for services may be more than our Preventive 100% of participating dentist fee
negotiated rates and you will be Basic Restorative 80% of participating dentist fee
billed for those higher costs .
Major Restorative 50% of participating dentist fee
Orthodontia 50% of participating dentist fee
Orthodontia Eligibility Available to children through age 19; the
process must be started prior
to age 17
Please see the plan documents on the NextCare Intranet beneits page for
out-of-network beneits.
Employee Dental Cost Per Pay Period
Employee Only $14 .46
Employee and Spouse $30 .36
Employee and Child(ren) $31 .81
Family $49 .16
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Preventive—oral NextCare offers dental insurance through Delta Dental of Arizona. Delta
Examinations, prophylaxis, Dental has a unique two-tiered network of PPO and Premier providers
bitewing x-rays, x-rays, topical
luoride applications, sealants, meaning a large network of options for your dental care.
and space maintainers
Basic—illings, injections of Providers in these networks will never “balance bill” participants or
antibiotic drugs, extractions, charge more than the agreed upon rates for services. Discounts may be
emergency palliative
treatment, anesthesia, deeper in the PPO network versus the Premier network. Talk to your
consultations, repairs, relining dentist about how they participate.
and rebasing, endodontics,
periodontics, and oral surgery An ID card will be mailed to you after enrollment. Visit
Major—crowns, inlays, on www.deltadentalaz.com to ind network providers, manage your claims,
lays, bridges, and dentures
and learn more about your dental care.
Balance Billing In-Network
Participating providers have agreed Deductible $50 individual
to speciic prices for procedures $150 family
in our plan . When you visit non-
participating providers, your cost Calendar Year Maximum $1,500 per member
for services may be more than our Preventive 100% of participating dentist fee
negotiated rates and you will be Basic Restorative 80% of participating dentist fee
billed for those higher costs .
Major Restorative 50% of participating dentist fee
Orthodontia 50% of participating dentist fee
Orthodontia Eligibility Available to children through age 19; the
process must be started prior
to age 17
Please see the plan documents on the NextCare Intranet beneits page for
out-of-network beneits.
Employee Dental Cost Per Pay Period
Employee Only $14 .46
Employee and Spouse $30 .36
Employee and Child(ren) $31 .81
Family $49 .16
8
