Page 10 - 2019 Sharks Benefits V6.1
P. 10
Dental Plan Options
Our convenient dental plan options are designed to allow employees the flexibility to choose between
two coverage levels.
Website: http://www.deltadentalins.com
Delta Dental
Benefits at a Glance
DHMO Plan PPO Premier Plan
Out-of-
In-Network In-Network Out-of-Network
Network
$50 per calendar $50 per calendar
Deductible None Not covered year (waived for year (waived for
preventative care) preventative care)
$150 per calendar $150 per calendar
Family Deductible None Not covered year (waived for year (waived for
preventative care) preventative care)
Annual Maximum $2,000 per person $2,000 per person
Benefit None Not covered per calendar year per calendar year
Co-Insurance
Preventative $0 - $240 Co-pay Not covered 100% 100%
Care
Basic Services $0 - $240 Co-pay Not covered 80% 80%
Major Services $0 - $240 Co-pay Not covered 50% 50%
Dependent Dependent
Child and Adult
Children only 50% Children only 50%
Orthodontia $25 - $1,900 Not covered $2,000 lifetime max $2,000 lifetime
co-pay
per person max per person
Employee Contributions Per Pay Period DHMO Plan PPO Premier Plan
With Delta Dental, you have access to a broad network of dentists through the Delta Dental national
dental network. The Network’s thousands of dental professionals have contracted to provide dental
service at negotiated fees which can significantly lower your out-of-pocket expense.
7
