Page 19 - Dawson 2022 Benefits Guide
P. 19
2022 Benefits Guide 19
DENTAL
We partner with Delta Dental of Colorado to offer you and Finding In-Network Providers
your family members dental insurance (coverage applies
to all locations, not just Colorado). Visit deltadentalco. Remember to visit in-network dentists to receive the
com to find in-network providers who participate in deepest level of discount on your services.
the Delta Dental PPO network and access a variety of
online tools and programs. While the plan will pay for To find a participating in-network dentist in
services from non-participating dentists, you will receive your area, go to deltadentalco.com or call
deeper discounts and maximum reimbursement if you 800.610.0201.
seek services from participating dentists.
Orthodontia Services Note
The lifetime maximum illustrated is different from
the calendar year maximum. For orthodontia
services, this limit does not reset each year, this is
the most your plan will cover for your services for
the lifetime of your participation in this program.
Examples of Covered Services
• Preventive—exams, cleanings, fluoride,
x-rays, and sealants
• Basic—fillings, extractions, periodontics,
repairs, and oral surgery
• Major—crowns, inlays, dentures, and
dental implants
* Non-participating services reimbursed at the 80th percentile
** Non-participating services reimbursed at the 90th percentile
This is a high-level summary of your benefit coverage. Full coverage details are available in your summary plan description (SPD).
In the event there is a discrepancy between what is reflected in this guide and what is communicated in your SPD, the terms of
your SPD will prevail.
EMPLOYEE PRETAX DENTAL
CONTRIBUTIONS
* During the two months in a year that have three pay
periods (July and December), premiums will only be
deducted from the first two paychecks.
DENTAL
We partner with Delta Dental of Colorado to offer you and Finding In-Network Providers
your family members dental insurance (coverage applies
to all locations, not just Colorado). Visit deltadentalco. Remember to visit in-network dentists to receive the
com to find in-network providers who participate in deepest level of discount on your services.
the Delta Dental PPO network and access a variety of
online tools and programs. While the plan will pay for To find a participating in-network dentist in
services from non-participating dentists, you will receive your area, go to deltadentalco.com or call
deeper discounts and maximum reimbursement if you 800.610.0201.
seek services from participating dentists.
Orthodontia Services Note
The lifetime maximum illustrated is different from
the calendar year maximum. For orthodontia
services, this limit does not reset each year, this is
the most your plan will cover for your services for
the lifetime of your participation in this program.
Examples of Covered Services
• Preventive—exams, cleanings, fluoride,
x-rays, and sealants
• Basic—fillings, extractions, periodontics,
repairs, and oral surgery
• Major—crowns, inlays, dentures, and
dental implants
* Non-participating services reimbursed at the 80th percentile
** Non-participating services reimbursed at the 90th percentile
This is a high-level summary of your benefit coverage. Full coverage details are available in your summary plan description (SPD).
In the event there is a discrepancy between what is reflected in this guide and what is communicated in your SPD, the terms of
your SPD will prevail.
EMPLOYEE PRETAX DENTAL
CONTRIBUTIONS
* During the two months in a year that have three pay
periods (July and December), premiums will only be
deducted from the first two paychecks.
