Page 15 - 2018 Intertek OE Main Guide
P. 15
2018 Benefits Enrollment
Dental Deductible/Maximum Delta Network Out-of-Network
Dental Coverage with Individual deductible $50 $50
$150
$150
Delta Dental Family deductible $1,500 $1,500
Calendar year maximum
Choose a Delta Dental PPO Coinsurance
dentist to ensure you receive the Preventive services 100% no deductible 100% no deductible
deepest discounts. Choose a (Exams, x-rays, cleanings)
Delta Premier dentist and receive Basic services 80% after deductible 80% after deductible
(Fillings, root canals, oral surgery)
discounts, although they may not Major services 50% after deductible 50% after deductible
be as deep as the PPO network. (Bridges, crowns, dentures)
If you receive care outside of Orthodontia
Delta’s PPO or Premier network Coinsurance 50% 50%
you will likely pay a greater Lifetime maximum $1,500 $1,500
Eligibility
Dependent children to age 26
amount for dental care and the
provider may balance bill you. Your Bi-Weekly Dental Contributions
Employee $4.85
To ind a Delta Dental network Employee + 1 $10.50
provider in your area go to Employee + 2+ $17.38
deltadentalins.com or call
800.521.2651. Learn more about the differences
between our dental networks by visiting
video.deltadentalins.com/videoplayer/
97588_Intertek_Testing_Holdings
15
Dental Deductible/Maximum Delta Network Out-of-Network
Dental Coverage with Individual deductible $50 $50
$150
$150
Delta Dental Family deductible $1,500 $1,500
Calendar year maximum
Choose a Delta Dental PPO Coinsurance
dentist to ensure you receive the Preventive services 100% no deductible 100% no deductible
deepest discounts. Choose a (Exams, x-rays, cleanings)
Delta Premier dentist and receive Basic services 80% after deductible 80% after deductible
(Fillings, root canals, oral surgery)
discounts, although they may not Major services 50% after deductible 50% after deductible
be as deep as the PPO network. (Bridges, crowns, dentures)
If you receive care outside of Orthodontia
Delta’s PPO or Premier network Coinsurance 50% 50%
you will likely pay a greater Lifetime maximum $1,500 $1,500
Eligibility
Dependent children to age 26
amount for dental care and the
provider may balance bill you. Your Bi-Weekly Dental Contributions
Employee $4.85
To ind a Delta Dental network Employee + 1 $10.50
provider in your area go to Employee + 2+ $17.38
deltadentalins.com or call
800.521.2651. Learn more about the differences
between our dental networks by visiting
video.deltadentalins.com/videoplayer/
97588_Intertek_Testing_Holdings
15
