Page 9 - Hussmann- Bridgeton OE Guide 2015 Plan Year
P. 9
Hussmann Corporation
Preventive Dental Care
When it comes to the health of your
Dental Benefits teeth and gums, preventive dental care
Out-of-
Delta Dental of Missouri In-Network Network is smart. Brushing and lossing help to
remove plaque from the surfaces and
Annual deductible waived for Per person $50 $50 in between teeth, keeping your teeth
preventative treatment
Per family $150 $150 looking and feeling clean. Routine
Maximum annual beneit Per person $1,500 dental exams and regular cleanings
Preventative care—for example: exams and Plan pays Plan pays 90% may help prevent the incidence
cleanings, luoride treatments, x-rays for 100% of covered of higher-cost treatments such as
diagnosis charges periodontal surgery, root canals,
Restorative care for example: illings, Plan pays Plan pays 72% extractions, and illings.
extractions, root canals, routine oral surgery 80% after of covered
deductible charges after
deductible
Major care services for example: dentures, Plan pays Plan pays 72%
bridgework, crowns 80% after of covered
deductible charges after
deductible
Orthodontic services coverage for dependents Plan pays Plan pays 45%
to age 19 50% after of covered
deductible charges after
deductible
Maximum lifetime orthodontia Per person $1,000
beneit combined for in-network
and out-of-network services
9
Preventive Dental Care
When it comes to the health of your
Dental Benefits teeth and gums, preventive dental care
Out-of-
Delta Dental of Missouri In-Network Network is smart. Brushing and lossing help to
remove plaque from the surfaces and
Annual deductible waived for Per person $50 $50 in between teeth, keeping your teeth
preventative treatment
Per family $150 $150 looking and feeling clean. Routine
Maximum annual beneit Per person $1,500 dental exams and regular cleanings
Preventative care—for example: exams and Plan pays Plan pays 90% may help prevent the incidence
cleanings, luoride treatments, x-rays for 100% of covered of higher-cost treatments such as
diagnosis charges periodontal surgery, root canals,
Restorative care for example: illings, Plan pays Plan pays 72% extractions, and illings.
extractions, root canals, routine oral surgery 80% after of covered
deductible charges after
deductible
Major care services for example: dentures, Plan pays Plan pays 72%
bridgework, crowns 80% after of covered
deductible charges after
deductible
Orthodontic services coverage for dependents Plan pays Plan pays 45%
to age 19 50% after of covered
deductible charges after
deductible
Maximum lifetime orthodontia Per person $1,000
beneit combined for in-network
and out-of-network services
9
