Page 10 - 2015 Reznor Union Enrollment Guide
P. 10
Open
Enrollment
Dental
Insurance Dental Insurance
How to Find a Dental You are offered two dental insurance options through Delta Dental of
Provider Rhode Island. You have the lexibility to choose any dentist you want;
Visit http://www.deltadentalri.com and however, when you choose an in-network dentist your services will be
select “Find a Dentist Nationwide” discounted. Services you receive out-of- network are not discounted.
Core Buy-Up
In-Network/ In-Network/
Out-of-Network Out-of-Network
Deductible
Individual N/A $50
Family N/A $150
Maximum
Calendar Year Maximum $1,000 $1,500
Coinsurance
Preventive Services (exams, 80% of MPA* 100%
x-rays, cleanings)
Basic Services (illings, root 80% of MPA* 85%
canals, oral surgery)
Major Services (bridges, 80% of MPA* 50%
crowns, dentures)
Orthodontia
Coinsurance 80% of MPA* 50%
Lifetime Maximum $800 $1,500
Eligibility Dependent children to age 19
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.
* MPA = Maximum Plan Allowance. You are not responsible for charges exceeding the MPA
if you go to a participating Delta Dentist. You are responsible for charges exceeding the
MPA if you go to a non-participating dentist.
10
Enrollment
Dental
Insurance Dental Insurance
How to Find a Dental You are offered two dental insurance options through Delta Dental of
Provider Rhode Island. You have the lexibility to choose any dentist you want;
Visit http://www.deltadentalri.com and however, when you choose an in-network dentist your services will be
select “Find a Dentist Nationwide” discounted. Services you receive out-of- network are not discounted.
Core Buy-Up
In-Network/ In-Network/
Out-of-Network Out-of-Network
Deductible
Individual N/A $50
Family N/A $150
Maximum
Calendar Year Maximum $1,000 $1,500
Coinsurance
Preventive Services (exams, 80% of MPA* 100%
x-rays, cleanings)
Basic Services (illings, root 80% of MPA* 85%
canals, oral surgery)
Major Services (bridges, 80% of MPA* 50%
crowns, dentures)
Orthodontia
Coinsurance 80% of MPA* 50%
Lifetime Maximum $800 $1,500
Eligibility Dependent children to age 19
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.
* MPA = Maximum Plan Allowance. You are not responsible for charges exceeding the MPA
if you go to a participating Delta Dentist. You are responsible for charges exceeding the
MPA if you go to a non-participating dentist.
10
