Page 13 - 2016 Enrollment

Dental

Dental Coverage with Delta Dental

Our dental plan, offered through Delta Dental, makes dental care more affordable
for employees and their families. Remember to choose an in-network dentist to
ensure you’re receiving the deepest level of discounted services.

To ind a Preferred Dental Program (PDP) participating in-network provider in
your area go to www.dentaldentalins.com or call 800.521.2651.

PDP In-Network Out-of-Network
Deductible/Maximum
Individual deductible $50 $50
Family deductible $150 $150
Calendar year maximum $1,500 $1,500
Coinsurance
Preventive services 100% no deductible 100% no deductible
(Exams, x-rays, cleanings)
Basic services 80% after deductible 80% after deductible
(Fillings, root canals, oral surgery)
Major services 50% after deductible 50% after deductible
(Bridges, crowns, dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime maximum $1,500 $1,500
Eligibility Dependent children to age 26

Employee Contributions
Employee $4.84
Employee + 1 $10.50
Employee + 2+ $17.38

13