Page 9 - Playmakers 2020 Renewal Benefits Booklet
P. 9
Playmakers, Inc. Dental Cost Analysis
Effective November 2020
Current Renewal
Delta Dental Delta Dental
PPO with EHB PPO with EHB
Rates Counts
Employee Only 11 $36.45 $36.45
Employee + 1 2 $70.13 $70.13
Employee + 2 3 $145.60 $145.60
Estimated Monthly Premium $978 $978
Percentage Change 0.00%
Annual Dollar Change $0
Deductible In-Network In-Network
Individual $25 $25
Family $75 $75
Annual Maximum
Individual $1,000 $1,000
Family $1,000 per member $1,000 per member
Class 1 100% 100%
Exams 100% 100% 100% 100%
Emergency Treatment for 80% 80% 80% 80%
Crowns, Inlays, Outlays 50% 50% 50% 50%
This is a summary analysis only. Refer to certificate of coverage for all specific details.
This summary is not a contract and makes no representations or warranties as to final outcomes of claim adjudication.
Deductible is waived for Class 1 (Preventative Services)
Rates do not include State Claims Tax
