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Dental (Delta Dental of New Jersey)

Regular dental exams can help you and your dentist detect problems in
the early stages when treatment is simpler and costs are lower. Keeping
your teeth and gums clean and healthy will help prevent most tooth
decay and periodontal disease, and is an important part of maintaining
your medical health.

Plan Provision Basic Plus
Annual Deductible (Self/Dual/Family) $50/$100/$150 None

Annual Maximum (per person) $1,500 $2,000

Preventive & Diagnostic Care 100% 100%
Basic Services 80% 80%

Major Restorative 25% 60%
Orthodontia 25% (up to $1,500) 50% (up to $2,500)

Carryover maximum which allows you to carryover 25% of unused benefit maximum up to $500
per year provided no more than 50% of the max is used and dental exam once a year.

Benefit In-Network
Vision (VSP)
Exam $20 copay
The vision plan covers routine Hardware Combined with exam
eye exams and also pays for a Frequency
portion of the cost of glasses or ▪ Exam 12 months

contact lenses if you need them. 12 months
▪ Lenses
24 months
Eye Care Benefit ▪ Frames
Frames $180 allowance for a wide
All eligible employees can sign
selection of frames
up for vision coverage offered
through VSP. The VSP coverage $200 allowance for
allows for $20 eye exams at featured frame brands
participating providers. 20% savings on the amount
over your allowance
Members receive an allowance
Lenses
for purchase of frames or
contacts every 12 or 24 months. ▪ Single Vision Lenses Combined with exam
▪ Bifocal Lenses
▪ Trifocal Lenses
Elective Contact Lenses in
$180 allowance
lieu of glasses
Laser Correction Surgery $500 off preferred program

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Your Benefit Guide 2020