Page 9 - NextCare Holdings 2022 Benefits Guide
P. 9
2022
NextCare Holdings Benefits Guide
DENTAL
NextCare ofers dental insurance through Delta In-Network
Dental of Arizona. Delta Dental has a unique two- Deductible $50 individual
tiered network of PPO and Premier providers $150 family
meaning a large network of options for your dental Calendar Year Maximum $1,500 per member
care. Preventive 100% of participating dentist fee
Basic Restorative 80% of participating dentist fee
Providers in these networks will never “balance bill” Major Restorative 50% of participating dentist fee
participants or charge more than the agreed upon Orthodontia 50% of participating dentist fee
rates for services. Discounts may be deeper in the Orthodontia Eligibility Available to children through age
19; the process must be started
PPO network versus the Premier network. Talk to prior to age 17
your dentist about how they participate.
Please see the plan documents on the NextCare
An ID card will be mailed to you after enrollment. Intranet beneits page for out-of-network beneits.
Visit www.deltadentalaz.com to ind network
providers, manage your claims, and learn more Employee Dental Cost Per Pay
about your dental care.
Period
Employee Only $14.46
Employee and Spouse $30.36
Employee and Child(ren) $31.81
Family $49.16
Example Services
X Preventive—oral Examinations, prophylaxis, bitewing x-rays, x-rays, topical luoride applications, sealants, and space
maintainers
X Basic—illings, injections of antibiotic drugs, extractions, emergency palliative treatment, anesthesia, consultations, repairs,
relining and rebasing, endodontics, periodontics, and oral surgery
X Major—crowns, inlays, on lays, bridges, and dentures
Balance Billing
Participating providers have agreed to speciic prices for procedures in our plan. When you visit non-participating providers, your
cost for services may be more than our negotiated rates and you will be billed for those higher costs.
9
NextCare Holdings Benefits Guide
DENTAL
NextCare ofers dental insurance through Delta In-Network
Dental of Arizona. Delta Dental has a unique two- Deductible $50 individual
tiered network of PPO and Premier providers $150 family
meaning a large network of options for your dental Calendar Year Maximum $1,500 per member
care. Preventive 100% of participating dentist fee
Basic Restorative 80% of participating dentist fee
Providers in these networks will never “balance bill” Major Restorative 50% of participating dentist fee
participants or charge more than the agreed upon Orthodontia 50% of participating dentist fee
rates for services. Discounts may be deeper in the Orthodontia Eligibility Available to children through age
19; the process must be started
PPO network versus the Premier network. Talk to prior to age 17
your dentist about how they participate.
Please see the plan documents on the NextCare
An ID card will be mailed to you after enrollment. Intranet beneits page for out-of-network beneits.
Visit www.deltadentalaz.com to ind network
providers, manage your claims, and learn more Employee Dental Cost Per Pay
about your dental care.
Period
Employee Only $14.46
Employee and Spouse $30.36
Employee and Child(ren) $31.81
Family $49.16
Example Services
X Preventive—oral Examinations, prophylaxis, bitewing x-rays, x-rays, topical luoride applications, sealants, and space
maintainers
X Basic—illings, injections of antibiotic drugs, extractions, emergency palliative treatment, anesthesia, consultations, repairs,
relining and rebasing, endodontics, periodontics, and oral surgery
X Major—crowns, inlays, on lays, bridges, and dentures
Balance Billing
Participating providers have agreed to speciic prices for procedures in our plan. When you visit non-participating providers, your
cost for services may be more than our negotiated rates and you will be billed for those higher costs.
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