Page 9 - 2016 Enrollment
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Dental
Fontbonne University continues to offer a comprehensive dental plan NOTE—Dental beneit
through Delta Dental. deductions are taken on a pre-
As in years past, Delta Dental offers two networks: a Premier network tax basis.
and a PPO network. You will ind the greatest discounts with providers Dental Contributions—Monthly
who are under the PPO network. Most providers in the PPO network are Employee only $6.80
also in the Premier network because it is a larger network. Note—dentists Employee + spouse $49.85
not in either network are considered non-participating providers; this Employee + child(ren) $55.50
means that they can balance bill you and require you to submit a claim. Family $73.65
When seeking treatment with a non-participating provider you may also
experience higher out-of-pocket expenses. It is always to your advantage
to seek treatment with an in-network provider.
Please visit deltadentalmo.com to search each network of providers.
Delta Dental of Missouri
Premier and Non-
PPO Dentist Participating Dentist Our dental coverage includes Delta’s
MAX Advantage. This very beneicial
Deductible feature excludes preventive service
Individual $50 $100 charges (exams, cleanings, etc), from
Family limit $100 $300 the calendar year maximum.
Applies to B & C B & C
Maximums
Calendar year maximum (A, B, and C) $1,500 $1,500
Orthodontic lifetime maximum (D) $1,500 $1,500
Coinsurance
Coverage A (preventive) 100% 100%
Coverage B (basic) 90% 80%
Coverage C (major) 60% 50%
Coverage D (orthodontic) 50% 50%
2016 Employee Benefits Guide
Dental
Fontbonne University continues to offer a comprehensive dental plan NOTE—Dental beneit
through Delta Dental. deductions are taken on a pre-
As in years past, Delta Dental offers two networks: a Premier network tax basis.
and a PPO network. You will ind the greatest discounts with providers Dental Contributions—Monthly
who are under the PPO network. Most providers in the PPO network are Employee only $6.80
also in the Premier network because it is a larger network. Note—dentists Employee + spouse $49.85
not in either network are considered non-participating providers; this Employee + child(ren) $55.50
means that they can balance bill you and require you to submit a claim. Family $73.65
When seeking treatment with a non-participating provider you may also
experience higher out-of-pocket expenses. It is always to your advantage
to seek treatment with an in-network provider.
Please visit deltadentalmo.com to search each network of providers.
Delta Dental of Missouri
Premier and Non-
PPO Dentist Participating Dentist Our dental coverage includes Delta’s
MAX Advantage. This very beneicial
Deductible feature excludes preventive service
Individual $50 $100 charges (exams, cleanings, etc), from
Family limit $100 $300 the calendar year maximum.
Applies to B & C B & C
Maximums
Calendar year maximum (A, B, and C) $1,500 $1,500
Orthodontic lifetime maximum (D) $1,500 $1,500
Coinsurance
Coverage A (preventive) 100% 100%
Coverage B (basic) 90% 80%
Coverage C (major) 60% 50%
Coverage D (orthodontic) 50% 50%
2016 Employee Benefits Guide
