Page 14 - 2018 Fontbonne Benefit Guide
P. 14
Dental
Fontbonne University continues to Please visit deltadentalmo.com to search each network of providers.
offer a comprehensive dental plan Delta Dental of Missouri
through Delta Dental. Premier and Non-
PPO Dentist
Participating Dentist
As in years past, Delta Dental offers Deductible
$50
two networks: a premier and non- Individual $100 $100
Family limit
$300
participating dentist network and a Applies to B & C B & C
PPO dentist network. You will ind Maximums
the greatest discounts with providers Calendar year maximum (A, B, and $1,500 $1,500
C)
who are under the PPO network. Most Orthodontic lifetime maximum (D) $1,500 $1,500
providers in the PPO network are Coinsurance
also in the premier network because Coverage A (preventive) 100% 100%
it is a larger network. Note—dentists Coverage B (basic) 90% 80%
60%
Coverage C (major)
50%
not in either network are considered Coverage D (orthodontic) 50% 50%
non-participating providers; this means
they can balance bill you and require Note—dental beneit deductions are taken on a pre-tax basis.
you to submit a claim. When seeking Dental Contributions—Monthly
treatment with a non-participating Employee only $7.25
provider you may also experience Employee + spouse $53.00
higher out-of-pocket expenses. It Employee + child(ren) $59.00
is always to your advantage to seek Family $77.50
treatment with an in-network provider.
Our dental coverage includes Delta’s MAX Advantage. This very beneicial
feature excludes preventive service charges (exams, cleanings, etc), from
the calendar year maximum.
14 2018 Benefits Enrollment
Fontbonne University continues to Please visit deltadentalmo.com to search each network of providers.
offer a comprehensive dental plan Delta Dental of Missouri
through Delta Dental. Premier and Non-
PPO Dentist
Participating Dentist
As in years past, Delta Dental offers Deductible
$50
two networks: a premier and non- Individual $100 $100
Family limit
$300
participating dentist network and a Applies to B & C B & C
PPO dentist network. You will ind Maximums
the greatest discounts with providers Calendar year maximum (A, B, and $1,500 $1,500
C)
who are under the PPO network. Most Orthodontic lifetime maximum (D) $1,500 $1,500
providers in the PPO network are Coinsurance
also in the premier network because Coverage A (preventive) 100% 100%
it is a larger network. Note—dentists Coverage B (basic) 90% 80%
60%
Coverage C (major)
50%
not in either network are considered Coverage D (orthodontic) 50% 50%
non-participating providers; this means
they can balance bill you and require Note—dental beneit deductions are taken on a pre-tax basis.
you to submit a claim. When seeking Dental Contributions—Monthly
treatment with a non-participating Employee only $7.25
provider you may also experience Employee + spouse $53.00
higher out-of-pocket expenses. It Employee + child(ren) $59.00
is always to your advantage to seek Family $77.50
treatment with an in-network provider.
Our dental coverage includes Delta’s MAX Advantage. This very beneicial
feature excludes preventive service charges (exams, cleanings, etc), from
the calendar year maximum.
14 2018 Benefits Enrollment
