Page 11 - 2017 Benefits Enrollment

Dental 2017 Beneits Enrollment

Dental Benefits Dental

Access to good oral healthcare is important to your overall health. This is why Sulzer coverage is
offers dental insurance as a core part of your beneits package. As with medical provided by Delta
insurance, you will almost always pay less if you visit an in-network dentist or Dental of Texas.

specialist. To locate an in-network provider, visit www.deltadentalins.com.

In-Network Out-of-Network
Reimbursed at the 80th
Delta PPO and Delta Premier percentile of UCR
Calendar Year Deductible
Individual $50 $50
Family $150 $150
Calendar Year Maximum $1,500 $1,500
Coinsurance
Preventive* 100% no deductible 100% no deductible
Basic 80% after deductible 80% after deductible
Major 50% after deductible 50% after deductible
Orthodontia
Coinsurance 50% no deductible 50% no deductible
Lifetime Maximum $1,500 $1,500
Benefit Applies To Adults and children Adults and children

* Preventive care does not apply to the annual maximum beneit.

2017 Employee Pre-Tax Contributions

Bi-weekly
Employee Only $4.20
Employee and Spouse $8.85
Employee and Child(ren) $8.70
Employee and Family $13.61

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