Page 13 - 2020 DAN Benefits Enrollment
P. 13
Dental Benefits
The dental plan administered by Delta Dental gives you the lexibility
to receive dental care in or out-of-network, although it usually will
cost you less when you visit a Delta Dental PPO dentist. For more
details see the dental plan summary plan description posted on
www.danbeneitsplus.com.
Standard Plan Enhanced Plan
(without Ortho) (with Ortho)
Employee Contributions Per Pay Period
Employee $6.50 $10.50
Employee + Spouse $12.50 $20.50
Employee + Child(ren) $13.50 $23.50
Family $19.00 $33.00
Carrier Delta Dental Delta Dental
Network PPO/Premier Out-of-Network PPO/Premier Out-of-Network
Deductible $50/$150 $50/$150
Annual Max $1,000 $2,000
Preventive 100% 100% 100% 100%
Annual Cleanings 2 3
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 orthodontia limit of $2,000 in the Enhanced Plan is a lifetime maximum.
Unlike your annual maximum, this lifetime orthodontia maximum is the
most your plan will pay for orthodontia services per member per lifetime. It
does not “reset” each year like your annual maximum.
Dentsu Aegis Network 13
The dental plan administered by Delta Dental gives you the lexibility
to receive dental care in or out-of-network, although it usually will
cost you less when you visit a Delta Dental PPO dentist. For more
details see the dental plan summary plan description posted on
www.danbeneitsplus.com.
Standard Plan Enhanced Plan
(without Ortho) (with Ortho)
Employee Contributions Per Pay Period
Employee $6.50 $10.50
Employee + Spouse $12.50 $20.50
Employee + Child(ren) $13.50 $23.50
Family $19.00 $33.00
Carrier Delta Dental Delta Dental
Network PPO/Premier Out-of-Network PPO/Premier Out-of-Network
Deductible $50/$150 $50/$150
Annual Max $1,000 $2,000
Preventive 100% 100% 100% 100%
Annual Cleanings 2 3
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 orthodontia limit of $2,000 in the Enhanced Plan is a lifetime maximum.
Unlike your annual maximum, this lifetime orthodontia maximum is the
most your plan will pay for orthodontia services per member per lifetime. It
does not “reset” each year like your annual maximum.
Dentsu Aegis Network 13
