Page 17 - 2016 Open Enrollment
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Dentsu Aegis Network (DAN)
Dental Plan
The dental plan administered by Delta Dental gives you the lexibility
to receive dental care in or out-of-network, although it usually will Dental Plan Summary
cost you less when you visit a Delta Dental PPO denist. For more
details see the dental plan summary plan descripion posted on
www.DANbeneitsPLUS.com.
NEW in 2016 We heard your requests, so in 2016 Adult
Orthodonia coverage will be added to the
Enhanced Plan.
Standard Plan Enhanced Plan
(without Ortho) (with Ortho)
2016 Employee Contribuions Per Pay Period
Employee $4.96 $8.93
Employee + Spouse $9.91 $17.84
Employee + Child(ren) $12.39 $22.30
Family $17.33 $31.22
Carrier Delta Dental Delta Dental
Out-of-
PPO/
PPO/
Out-of-
Network Premier Network Premier Network
Deducible $50/$150 $50/$150
Annual Max $1,000 $2,000
Prevenive 100% 100% 100% 100%
Basic 80% 80% 100% 80%
Major 50% 50% 60% 50%
Ortho (Adult and Child) Not Not 50% to $2,000
Covered Covered
Purple text indicates a beneit change.
A Note About Dental Coverage
Your annual maximum illustrated here is the most your plan will pay
toward your dental services in a given year. This annual maximum applies
to each person covered on the plan.
The orthodonia limit of $2,000 in the Enhanced Plan is a lifeime maximum.
Unlike your annual maximum, this lifeime orthodonia maximum is the
most your plan will pay for orthodonia services per member per lifeime. It
does not “reset” each year like your annual maximum.
17
Dental Plan
The dental plan administered by Delta Dental gives you the lexibility
to receive dental care in or out-of-network, although it usually will Dental Plan Summary
cost you less when you visit a Delta Dental PPO denist. For more
details see the dental plan summary plan descripion posted on
www.DANbeneitsPLUS.com.
NEW in 2016 We heard your requests, so in 2016 Adult
Orthodonia coverage will be added to the
Enhanced Plan.
Standard Plan Enhanced Plan
(without Ortho) (with Ortho)
2016 Employee Contribuions Per Pay Period
Employee $4.96 $8.93
Employee + Spouse $9.91 $17.84
Employee + Child(ren) $12.39 $22.30
Family $17.33 $31.22
Carrier Delta Dental Delta Dental
Out-of-
PPO/
PPO/
Out-of-
Network Premier Network Premier Network
Deducible $50/$150 $50/$150
Annual Max $1,000 $2,000
Prevenive 100% 100% 100% 100%
Basic 80% 80% 100% 80%
Major 50% 50% 60% 50%
Ortho (Adult and Child) Not Not 50% to $2,000
Covered Covered
Purple text indicates a beneit change.
A Note About Dental Coverage
Your annual maximum illustrated here is the most your plan will pay
toward your dental services in a given year. This annual maximum applies
to each person covered on the plan.
The orthodonia limit of $2,000 in the Enhanced Plan is a lifeime maximum.
Unlike your annual maximum, this lifeime orthodonia maximum is the
most your plan will pay for orthodonia services per member per lifeime. It
does not “reset” each year like your annual maximum.
17
