Page 10 - 2017 Employee Benefit Highlights

Maximizing your dental insurance plan

Dental insurance

Decision #1 | should you take it

Participating Delta Dental PPO dentists have agreed to accept a The Delta Dental PPO plan
reduced fee for services; however, you have the freedom to see any emphasizes choice and helps you
licensed dentist you choose. Benefits are provided whether you save on your dental care costs
choose an In-Network Delta Dental PPO dentist or a Out-of-
Network (non-participating) dentist. when seeing a Delta Dental
PPO dentist.
• If you choose to use a non-participating dentist you will
incur additional out-of-pocket expenses and you will be
billed the total amount the dentist charges (called balance- Calendar year deductible (waived for preventive care)
billing). When you see a PPO or Premier dentist, you are Individual / Family $50 / $150
protected from balance-billing.
Maximum benefit
Calendar year $1,500 per person
Please note: It is recommended that when a course of treatment is Orthodontic lifetime Up to $1,500 per person
expected to cost $300 or more, and is of a non-emergency nature,
your dentist should submit a treatment plan before he/she begins. The dental plan has a calendar year deductible. The deductible
This enables you to see what your out-of-pocket expenses will be so begins on January 1st and ends on December 31st of each year.
you are not surprised and can budget accordingly.
In-Network Out-of-Network
Preventive 100% 90%
Go to deltadentalins.com to obtain a list of PPO dentists or you can
always simply contact your current provider to see if he or she is a Diagnostic 100% 90%
90%
80%

member of the Delta Dental network. Basic
Major 60% 50%
Orthodontic 50% 50%
Decision #2 | who should you cover
Diagnostic and preventive benefits:
Oral evaluation and routine cleaning and bitewing x-rays [limited
Each of these levels of coverage carries a different employee to twice per calendar year]; Full-mouth x-rays or panoramic x-rays
contribution (the pre-taxed amount you pay per paycheck) toward [once every 3 years}; Emergency and palliative treatment to relieve
the total dental premium. pain; Fluoride treatments up to age 19; Space maintainers for
posterior primary teeth up to age 14, and Sealants up to age 15 on
You only $7 unrestored molars [one per tooth every 2 years.]
You + Spouse $15 Basic benefits:
Oral surgery; General anesthesia; Antibiotics; Endodontics;
You + Child(ren) $12 Periodontics; Gas (nitrous oxide); Restorative: amalgam, synthetic
You + Family $23 porcelain, plastic restorations (fillings) and prefabricated stainless
steel restorations for treatment of carious lesions (visible
destruction of hard tooth structure resulting from the process of
decay); and Denture Repair.
Major benefits:
Crowns, Inlays/Onlays and Cast Restoration; and Prosthodontics
Orthodontic benefits:
Benefit is covered at 50% of charges up to a lifetime maximum
of $1,500.
For additional details on benefits, limitations and exclusions visit
deltadentalins.com.

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