Page 5 - 2020 Wiese Benefits Guide
P. 5
2020
Wiese Benefits Enrollment
DENTAL To Find a Provider
Dental Plan—Delta Dental Go to deltadentalmo.com
We partner with Delta Dental of Missouri for our dental carrier. Please Click the “Find a Provider” link
see below for a high level plan design and an outline of payroll premiums. Under Find a Dentist, follow
the link that says “Click
Here to Find A Dental
Service PPO/Premier and Out-of-Network* Care Provider”
Calendar Year Maximum $1,500 Select the Specialty you’re
Deductible $50 individual/$150 family searching for
Preventive Services* 100% Choose the Delta Dental PPO
Basic Services* 80% Plus Premier Network
Major Services* 50% Click on “Find Dentists”
Orthodontics 50%
Lifetime Maximum $1,500
* Out-of-network reimbursements are based upon Delta Dental’s reasonable and customary
charges. You will receive a greater beneit by visiting an in-network provider.
Team Member Cost Per Week
TM Only $2 .25
TM + Spouse $4 .25
TM + Child(ren) $3 .50
TM + Family $5 .50
5
Wiese Benefits Enrollment
DENTAL To Find a Provider
Dental Plan—Delta Dental Go to deltadentalmo.com
We partner with Delta Dental of Missouri for our dental carrier. Please Click the “Find a Provider” link
see below for a high level plan design and an outline of payroll premiums. Under Find a Dentist, follow
the link that says “Click
Here to Find A Dental
Service PPO/Premier and Out-of-Network* Care Provider”
Calendar Year Maximum $1,500 Select the Specialty you’re
Deductible $50 individual/$150 family searching for
Preventive Services* 100% Choose the Delta Dental PPO
Basic Services* 80% Plus Premier Network
Major Services* 50% Click on “Find Dentists”
Orthodontics 50%
Lifetime Maximum $1,500
* Out-of-network reimbursements are based upon Delta Dental’s reasonable and customary
charges. You will receive a greater beneit by visiting an in-network provider.
Team Member Cost Per Week
TM Only $2 .25
TM + Spouse $4 .25
TM + Child(ren) $3 .50
TM + Family $5 .50
5
