Page 10 - Siemens Gamesa 2022 PY Benefits Guide
P. 10
Dental
Regular dental exams can help 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 essential
part of maintaining your medical health.
Delta Dental Basic Plan Delta Dental Enhanced Plan
Provision In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible $50/$150 $25/$75 $75/$225
(Individual/Family)
Annual Maximum
(per person) $1,500 $2,000
Diagnostic and Preventive 100%, 100%, 100%, 100%,
Includes cleanings, fluoride treatments, no deductible no deductible no deductible no deductible
sealants and x-rays MCR 90th MRC 90th
Basic Restorative Care 80%, 60%, 80%, 60%,
Includes fillings, periodontics, scaling and after deductible after deductible after deductible after deductible
root planing, oral surgery MRC 90th MRC 90th
50%, 50%,
Major Services 50%, after deductible 60%, after deductible
Includes crowns, bridges, and dentures after deductible after deductible
MCR 90th MRC 90th
50%, 50%,
50%, 60%,
Implants after deductible after deductible
after deductible after deductible
MCR 90th MRC 90th
40%
50%
Orthodontia MRC 90th
(Child and adults) Not Covered $2,000 lifetime $2,000 lifetime
maximum
maximum
10 Your Benefits | Your Decisions Your Benefits | Your Decisions 11
