Page 16 - Dentsu 2022 Annual Enrollment Flyer
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Dental Benefits
The dental plan administered by Delta Dental gives you the flexibility to receive dental care in or
out-of-network, although it usually will cost you less when you visit a Delta Dental PPO dentist.
Standard Plan Enhanced Plan
(without Ortho) (with Ortho)
Contributions Per Semi Monthly Pay Period
Employee $7.00 $11.00
Employee + Spouse/DP $13.00 $21.50
Employee + Child(ren) $14.00 $24.50
Family $19.50 $34.50
Carrier Delta Dental Delta Dental
Network PPO/Premier Out-of-Network PPO/Premier Out-of-Network
Deductible $50/$150 $50/$150
Annual Max $1,000 $2,000
Preventive 100% 100% 100% 100%
Annual Cleanings 2 3
Basic 80% 80% 100% 80%
Major 50% 50% 60% 50%
Orthodontia (Adult and Child) Not Covered 50% to $2,000
A Note About Dental Coverage
Your annual maximum illustrated here is the most your plan will pay toward your dental services
in a given year. This annual maximum applies to each person covered on the plan.
The orthodontia limit of $2,000 in the Enhanced Plan is a lifetime maximum. Unlike your annual
maximum, this lifetime orthodontia maximum is the most your plan will pay for orthodontia
services per member per lifetime. It does not “reset” each year like your annual maximum.
16 2022 Benefits Enrollment
The dental plan administered by Delta Dental gives you the flexibility to receive dental care in or
out-of-network, although it usually will cost you less when you visit a Delta Dental PPO dentist.
Standard Plan Enhanced Plan
(without Ortho) (with Ortho)
Contributions Per Semi Monthly Pay Period
Employee $7.00 $11.00
Employee + Spouse/DP $13.00 $21.50
Employee + Child(ren) $14.00 $24.50
Family $19.50 $34.50
Carrier Delta Dental Delta Dental
Network PPO/Premier Out-of-Network PPO/Premier Out-of-Network
Deductible $50/$150 $50/$150
Annual Max $1,000 $2,000
Preventive 100% 100% 100% 100%
Annual Cleanings 2 3
Basic 80% 80% 100% 80%
Major 50% 50% 60% 50%
Orthodontia (Adult and Child) Not Covered 50% to $2,000
A Note About Dental Coverage
Your annual maximum illustrated here is the most your plan will pay toward your dental services
in a given year. This annual maximum applies to each person covered on the plan.
The orthodontia limit of $2,000 in the Enhanced Plan is a lifetime maximum. Unlike your annual
maximum, this lifetime orthodontia maximum is the most your plan will pay for orthodontia
services per member per lifetime. It does not “reset” each year like your annual maximum.
16 2022 Benefits Enrollment
