Page 11 - 2017 Benefits Enrollment
P. 11
Dentsu Aegis Network (DAN)
Dental Plan
The dental plan administered by Delta Dental gives you the lexibility to Dental Plan
receive dental care in or out-of-network, although it usually will cost you less Summary
when you visit a Delta Dental PPO denist. For more details see the dental
plan summary plan descripion posted on www.DANbeneitsPLUS.com.
Standard Plan Enhanced Plan
(without Ortho) (with Ortho)
2017 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
PPO/
PPO/
Out-of-
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 Covered Not Covered 50% to $2,000
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.
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Dental Plan
The dental plan administered by Delta Dental gives you the lexibility to Dental Plan
receive dental care in or out-of-network, although it usually will cost you less Summary
when you visit a Delta Dental PPO denist. For more details see the dental
plan summary plan descripion posted on www.DANbeneitsPLUS.com.
Standard Plan Enhanced Plan
(without Ortho) (with Ortho)
2017 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
PPO/
PPO/
Out-of-
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 Covered Not Covered 50% to $2,000
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.
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