Page 15 - 2015 Reznor Salary Enrollment Guide

Nortek

Dental Insurance

Nortek offers dental insurance through Delta Dental of Rhode Island. Dental
You can use dentists in Delta’s PPO or Premier network—or you can Insurance
go out-of-network. Services you receive in either the PPO network
or the Premier network will be discounted, but services in the PPO How to Find a Dental
Provider
network are discounted more than Premier network services. Out-of-
network services are not discounted. Visit http://www.deltadentalri.com
and select “Find a Dentist Nationwide”,
then choose either the PPO or Premier
Both the Basic and the Basic Plus plans max out at $1,500 per calendar Network .
year of company coverage. Your deductible is only $50 for individual
coverage, or $150 for you and your spouse or family.

Basic Basic Plus

In-Network Out-of- In-Network Out-of-
PPO &
PPO & Premier Network Premier Network
Calendar Year Deductible
Individual $50 $50
Family $150 $150
Calendar Year $1,500 $1,500
Maximum
Coinsurance
Preventive 100% no 90% no 100% no deductible
deductible deductible
Basic 80% after 70% after 80% after deductible
deductible deductible
Major 50% after 40% after 50% after deductible
deductible deductible
Orthodontia
Coinsurance N/A 50%
Lifetime Maximum N/A $1,500
Various Services
Visits & Exams 100% no 90% no 100% no deductible
deductible deductible
X-rays 100% no 90% no 100% no deductible
deductible deductible
Endodontics 80% after 70% after 80% after deductible
deductible deductible
Minor Restorations 80% after 70% after 80% after deductible
deductible deductible
Periodontics 80% after 70% after 80% after deductible
deductible deductible
Prosthodontics/Major 50% after 40% after 50% after deductible
Restorations deductible deductible

Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description,
the terms of the SPD will prevail.

15