COVERED YOUR SMILE IS DELTACARE USA: PROVIDED BY DELTA DENTAL INSURANCE COMPANY
|
|
- Anthony Dennis
- 5 years ago
- Views:
Transcription
1 DELTACARE USA: PROVIDED BY DELTA DENTAL INSURANCE COMPANY YOUR SMILE IS COVERED DENTAL BENEFITS MADE EASY! When you enroll in a DeltaCare USA 1 plan, you ll choose a primary care dentist from our network of carefully screened, private practice dentists. You must visit your primary care dentist to receive benefits. 2 > No restrictions on pre-existing conditions (except work in progress) > Access to specialty care and out-of-area emergency care A PARTNER IN ORAL HEALTH Your DeltaCare USA plan encourages regular dental care with an extensive list of covered services to help you stay healthy. > Low or no copayments for services like cleanings and exams BUDGET-FRIENDLY COSTS With your DeltaCare USA plan, there are no surprises. You ll know your copayments, and your out-of-pocket costs are clearly defined before treatment begins. > No deductibles or maximums for covered services > Pay only your copayment (if any) at the time of treatment CONVENIENT SERVICES We make it easy for you there are no claim forms to complete, and no plan ID card is required to receive treatment. > Access plan information online > Change your primary care dentist by phone or online LEGAL NOTICES: Access federal and state legal notices related to your plan: deltadentalins.com/about/legal/indexenrollee.html 1 The DeltaCare USA plan is underwritten in these states by these entities: AL Alpha Dental of Alabama, Inc.; AZ Alpha Dental of Arizona, Inc.; CA Delta Dental of California; AR, CO, IA, MA, MI, NE, OR, RI, SC, WA, WI Dentegra Insurance Company; DC, DE, FL, GA, KS, TN, WV Delta Dental Insurance Company; HI, ID, IL, IN, KY, MD, MO, NJ, OH, TX Alpha Dental Programs, Inc.; NV Alpha Dental of Nevada, Inc.; UT Alpha Dental of Utah, Inc.; NM Alpha Dental of New Mexico, Inc.; NY Delta Dental of New York, Inc.; PA Delta Dental of Pennsylvania; VA Delta Dental of Virginia. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially responsible for their own products. 2 Verify that the dentist is your selected DeltaCare USA primary care dentist before each appointment. Administered by Delta Dental Insurance Company SCFLSTD HL_DCU_FL15B #89627
2 USEFUL INFORMATION AT YOUR FINGERTIPS CHECK OUT OUR SMILEWAY WELLNESS PROGRAM Find oral health resources, including a risk self-assessment tool, quizzes, articles, videos and a subscription to Grin!, our free dental wellness e-magazine, at mysmileway.com. FIND A NETWORK DENTIST NEAR YOU Use our convenient Find a Dentist tool and select DeltaCare USA as your network. > Find a dentist near your home or office > Change your primary care dentist SIGN UP FOR AN ONLINE ACCOUNT AT DELTADENTALINS.COM Use your mobile device or desktop to sign up for a free, secure Online Services account. > Review your plan benefits > Access your ID card CONTACT US Need help? Let us know. ONLINE: Visit deltadentalins.com/about/contact/contactus_ddic.html and choose the DeltaCare USA Customer Service form. WRITE TO: DeltaCare USA Customer Service P.O. Box 1803 Alpharetta, GA CALL TOLL-FREE: Customer Service agents are available Monday through Friday, 8 a.m. to 9 p.m., Eastern time. Or, use our interactive automated voice response system, available 24/7. Underwritten by: Delta Dental Insurance Company 1130 Sanctuary Parkway Alpharetta, GA Administered by: Delta Dental Insurance Company 1130 Sanctuary Parkway Alpharetta, GA NOTE: THIS IS ONLY A BRIEF SUMMARY OF YOUR PLAN. This brochure is not intended to replace your legally required plan booklet. The Group Dental Service Contract determines the exact terms and conditions of your coverage. Please refer to the Description of Benefits and Copayments and Limitations and Exclusions of Benefits in this brochure for a complete list of covered procedures, copayments, plan limitations and exclusions. You may also consult your Evidence/Certificate of Coverage, which will be mailed to you upon enrollment. If you wish to review an Evidence/Certificate of Coverage prior to enrollment, you may request a copy by calling Customer Service at IMPORTANT: Can you read this document? If not, we can have somebody help you read it. For free help, please call Delta Dental at IMPORTANTE: Puede leer este documento? Si no, podemos ayudarle. Para obtener ayuda gratis, llame a Delta Dental al 重要通知 : 您能讀這份文件嗎? 如有問題, 我們可請他人協助您 如需免費協助, 請電 Delta Dental Copyright 2015 Delta Dental. All rights reserved.
3 DeltaCare USA 15B Plan Highlights The DeltaCare USA plan provides great dental benefits and predictable costs. With defined copayments 1, enrollees know their share of the cost for covered services before their dental visit. Copayments for some of the most common services are listed below. To obtain a complete list of covered services, along with any limitations and exclusions that apply, select the contact us link from the website or call us at Summary of Covered Services 2 Category Procedure Code and Description 3 Copayment Amount 1 D Office visit $5 Diagnostic & Preventive Services (D & P) D Periodic oral exam established patient D Comprehensive oral evaluation new or established patient D Complete series of x-rays D Periapical x-ray of tooth's root D Periapical x-ray of tooth s root, each additional image D Bitewing x-rays (2 images) D Bitewing x-rays (4 images) D Panoramic x-ray D Prophylaxis (cleaning) adult $5 D Prophylaxis (cleaning) child $5 D Fluoride treatment D Sealant per tooth $15 D Amalgam (silver-colored) filling 1 surfaces $8 D Amalgam (silver-colored) filling 2 surfaces $12 D Amalgam (silver-colored) filling 3 surfaces $18 D Resin (tooth-colored) filling, front tooth, 1 surface $22 Basic Services D Resin (tooth-colored) filling, front tooth, 2 surfaces $26 D Resin (tooth-colored) filling, front tooth, 3 surfaces $30 D Resin (tooth-colored) filling, back tooth, 1 surface $65 D Resin (tooth-colored) filling, back tooth, 2 surfaces $75 D Resin (tooth-colored) filling, back tooth, 3 surfaces $85
4 Category Procedure Code and Description 3 Copayment Amount 1 D Root canal, front tooth $125 Endodontics D Root canal, bicuspid tooth $215 D Root canal, molar tooth $365 Periodontics Oral Surgery D Periodontal surgery, per quadrant $308 D Periodontal scaling and root planing four or more teeth per quadrant D Periodontal maintenance $45 D Extraction (removal) of a fully exposed tooth $14 D Surgical extraction or erupted (exposed) tooth $55 D Extraction (removal) of fully impacted tooth, completely bony $60 $120 D Crown, porcelain and precious metal $395 D Crown, precious metal $395 Major Services D Full upper denture $365 Orthodontics D Bridge pontic, porcelain and precious metal $395 D Bridge crown, porcelain and precious metal $395 D Limited orthodontic treatment of the primary dentition D Limited orthodontic treatment of the transitional dentition - child or adolescent to age 19 D Limited orthodontic treatment of the adolescent dentition adolescent to age 19 D Limited orthodontic treatment of the adult dentition - adults, including covered dependent adult children D Interceptive orthodontic treatment of the primary dentition D Interceptive orthodontic treatment of the transitional dentition D Comprehensive orthodontic treatment of the transitional dentition - child or adolescent to age 19 D Comprehensive orthodontic treatment of the adolescent dentition adolescent to age 19 D Comprehensive orthodontic treatment of the adult dentition - adults, including covered dependent adult children D Pre-orthodontic treatment examination to monitor growth and development D Orthodontic retention (removal of appliances, construction and placement of removable retainers) A copayment is the amount the enrollee pays for covered services at the time of treatment. $1,350 $1,900 $1,900 $2,100 The summary of benefits featured above represent the most frequently used services covered under your plan; other services are also covered. All services are subject to the limitations and exclusions of the plan. Copayments and procedure descriptions referenced above are intended to clarify the delivery of benefits under the DeltaCare USA plan and are not to be interpreted as CDT-2014 descriptors or nomenclature, which are under copyright by the American Dental Association. The American Dental Association may periodically change CDT codes or definitions. Such updated codes, descriptors and nomenclature may be used to describe these covered procedures in $25 $275
5 Keep Smiling Delta Dental PPO SM Stay in network to save Visit a dentist in the PPO 1 network to maximize your savings. 2 These dentists have agreed to reduced fees, and you won t get charged more than your expected share of the bill. 3 Find a PPO dentist at deltadentalins.com. 4 If you can t find a PPO dentist, Delta Dental Premier dentists offer the next best opportunity to save. Unlike non Delta Dental dentists, they have agreed to set fees, and you won t get charged more than your expected share of the bill. Set up an online account Get information about your plan anytime, anywhere by signing up for an Online Services account at deltadentalins.com. Available once your coverage kicks in, this free service lets you check benefits and eligibility information, find a network dentist and more. Check in without an ID card You don t need a Delta Dental ID card when you visit the dentist. Just provide your name, birth date and enrollee ID or social security number. If your family members are covered under your plan, they will need to provide your information. Prefer to take a paper or electronic ID card with you? Simply sign in to Online Services, where you can view or print your card with the click of a button. Coordinate dual coverage If you re covered under two plans, ask your dental office to include information about both plans with your claim, and we ll handle the rest. Understand transition of care Did you start on a dental treatment plan before your PPO coverage kicked in? Generally, multistage procedures are only covered under your current plan if treatment began after your plan s effective date of coverage. 5 You can find this date by logging in to Online Services. Newly covered? Visit deltadentalins.com/welcome. Save with a PPO dentist PPO NON-PPO NON DELTA DENTAL 1 In Texas, Delta Dental Insurance Company offers a Dental Provider Organization (DPO) plan. 2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-ppo dentist. Network dentists are paid contracted fees. 3 You are responsible for any applicable deductibles, coinsurance, amounts over plan maximums and charges for non-covered services. 4 We recommend verifying before each appointment that your dentist is a PPO dentist. 5 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for any costs. Group- and state-specific exceptions may apply. Enrollees currently undergoing active orthodontic treatment may be eligible to continue treatment under Delta Dental PPO. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan. LEGAL NOTICES: Access federal and state legal notices related to your plan at deltadentalins.com/about/legal/index-enrollee.html. Copyright 2016 Delta Dental. All rights reserved. HL_PPO_PRE #96083F (rev. 5/16)
6 Plan Benefit Highlights for: TopBuild Corp. Group No: Eligibility Deductibles Deductibles waived for Diagnostic & Preventive (D & P) and Orthodontics? Maximums D & P counts toward maximum? Waiting Period(s) Primary enrollee, spouse (includes domestic partner) and eligible dependent children to the end of the month dependent turns age 26 $50 per person / $150 per family each calendar year Yes $1,500 per person each calendar year Yes Basic Benefits Major Benefits Prosthodontics Orthodontics Benefits and Covered Services* Diagnostic & Preventive (D & P) Services Exams, cleanings, x-rays and sealants Basic Benefits Fillings Endodontics (root canals) Covered Under Basic Services Periodontics (gum treatment) Covered Under Basic Services Oral Surgery Covered Under Basic Services Major Benefits Crowns, inlays, onlays, cast restorations and TMJ Prosthodontics Bridges, dentures and implants Delta Dental PPO dentists** Delta Dental Premier dentists** Non-Delta Dental dentists** 100 % 100 % 80 % 60 % 60 % 40 % 60 % 60 % 40 % Orthodontic Benefits Dependent children 50 % 50 % 50 % Orthodontic Maximums $1,000 Lifetime $1,000 Lifetime $1,000 Lifetime * Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist s submitted fees. ** Reimbursement is based on PPO contracted fees for PPO dentists, Delta Dental Premier contracted fees for Premier dentists and Premier contracted fees for non-delta Dental PPO dentists. Delta Dental Insurance Company 1130 Sanctuary Parkway, Suite 600 Alpharetta, GA Customer Service Claims Address P.O. Box 1809 Alpharetta, GA deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company s benefits representative. HLT_PPO_3COL_DDIC (Rev. 10/05/2016)
Keep Smiling. DeltaCare USA. provided by Delta Dental of California. Budget-friendly costs. Dental benefits made easy! Convenient services
Keep Smiling DeltaCare USA provided by Delta Dental of California Dental benefits made easy! When you enroll in a DeltaCare USA 1 plan, you ll choose a primary care dentist from our network of carefully
More informationChoosing your plan. City of Sacramento. We ll do whatever it takes and then some. Your Two Delta Dental Plan Options
City of Sacramento Choosing your plan Your Two Delta Dental Plan Options The choice is yours. When it comes to dental health, you want benefits that provide you with the best balance of value and coverage.
More informationKeep Smiling Delta Dental PPO SM
Keep Smiling Delta Dental PPO SM Save with PPO Visit a dentist in the PPO 1 network to maximize your savings. 2 These dentists have agreed to reduced fees, and you won t get charged more than your expected
More informationEnroll in DeltaCare USA and you ll enjoy these features: you and your family. conditions covered,
DeltaCare USA provided by Delta Dental of California Quality Convenience Predictable Costs DELTACARE USA We ll do whatever it takes and then some. Welcome to DeltaCare USA - quality, convenience, predictable
More informationYour Smile, Your Choice
Your Smile, Your Choice Delta Dental PPO SM & DeltaCare USA Your company lets you choose between two dental plans from Delta Dental. Either way, you ll get reliable dentist networks and affordable preventive
More informationChoosing your plan. Northern California Carpenters Pension Trust Fund Retirees. We ll do whatever it takes and then some.
Northern California Carpenters Pension Trust Fund Retirees Choosing your plan Your Two Delta Dental Plan Options The choice is yours. When it comes to dental health, you want benefits that provide you
More informationKeep Smiling. DeltaCare USA. We keep you smiling
Keep Smiling DeltaCare USA We keep you smiling FAQ+A Answers to frequently asked questions about your DeltaCare USA plan GETTING STARTED 1. How do I enroll in a DeltaCare USA plan? Simply complete the
More informationCOVERED DELTA DENTAL PPO YOUR SMILE IS SAVE WITH A PPO DENTIST NON-DELTA
DELTA DENTAL PPO : YOUR SMILE IS COVERED GO PPO! You can visit any licensed dentist under this plan, but you ll maximize plan value by selecting a Delta Dental PPO 1 dentist. PPO network dentists have
More information2014 Rates. About Delta Dental networks BENEFITS OVERVIEW. Employee Only: $ Employee & Spouse: $ Employee & Child(ren): $83.
BENEFITS OVERVIEW Benefit Summary for: Denny s, Inc. Effective Date: January 1, 2014 Plan Option: HIGH PLAN Delta Dental PPO Dentacare M Delta Dental PPO & Premier Non- Participating Providers Part-Time
More informationBrevard Public Schools
Brevard Public Schools Your Delta Dental Benefits Plan Delta Dental PPO High & Low Option Plan Highlights Diagnostic & Preventive Maximum Waiver Benefit Missing Teeth Covered Composite Fillings Covered
More informationBASS PRO, INC. / CABELA S
PPO BASE PLAN - Features BASS PRO, INC. / CABELA S BASE PLAN 2019 PPO Dentist Based on PPO reduced maximum plan allowance Premier Dentist Based on Premiermaximum plan allowance Non-Participating Dentist
More informationYour Dental Benefits The Local Choice. Retiree Health Benefits Program for Medicare-Eligible Retirees
Your Dental Benefits The Local Choice Retiree Health Benefits Program for Medicare-Eligible Retirees Welcome to Delta Dental of Virginia In addition to the largest network of dentists in the nation* and
More informationTHE CALIFORNIA STATE UNIVERSITY DENTAL PROGRAM OVERVIEW
THE CALIFORNIA STATE UNIVERSITY DENTAL PROGRAM OVERVIEW Plan Year: January 1, 2019 December 31, 2019 The California State University Dental Program consists of two types of plans: Delta Dental PPO and.
More informationNon-PPO dentists: $10 per person each calendar year Deductibles waived for Diagnostic & Preventive (D & P)? Non-PPO dentists: Yes
Plan Benefit Highlights for: County of Stanislaus (Buy-Up Plan, Actives) Group No: 03351-00003 In this incentive plan, Delta Dental pays 70% of the PPO contract allowance for covered diagnostic, preventive
More informationDental Benefit Summary
TriNet Group Number: 00499262 Dental Benefit Summary About Your Benefits: A visit to your dentist can help you keep a great smile and prevent many health issues. But dental care can be costly and you can
More informationAnthem Blue Dental PPO Voluntary Option 2V Summary of Benefits
Anthem Blue Dental PPO Voluntary Option 2V Summary of Benefits Annual Benefit Limit: $1500 Annual Member Deductible: $50 PPO Dentist $50 Non-PPO Dentist Family Coverage Deductible Limit 3 times Annual
More informationFederal Employee Dental Options Guide for Lovelace FEHB Plan Members
Federal Employee Dental Options 2014 Guide for Lovelace FEHB Plan Members Option 1: Sandia Plan The Sandia Plan is the most economic dental plan option. Members obtain dental services from our ever expanding
More informationYour Dental Benefits. The Local Choice Dental Benefits Program
Your Dental Benefits The Local Choice Dental Benefits Program WELCOME to Delta Dental of Virginia In addition to the largest network of dentists in Virginia* and valuable benefits that help keep out-of-pocket
More informationEUTF and HSTA VB Retirees Group Number 2601 Dental Plan Benefits
EUTF and HSTA VB Retirees Group Number 2601 Dental Plan Benefits A lifetime of healthy smiles for Hawai i families This brochure includes a brief description of your HDS dental benefits. All benefits are
More informationA Dental Benefits Program For Individuals and Families Group #2525. HDS. A plan that puts a smile on your face.
A Dental Benefits Program For Individuals and Families Group #2525 HDS. A plan that puts a smile on your face. Your Dental Benefits The health of your teeth and gums directly affects your overall health.
More informationExclusive Panel Option (EPO 1-B) a feature of the Delta Dental PPO Denver Public Schools- Group #
Exclusive Panel Option (EPO 1-B) a feature of the Delta Dental PPO Denver Public Schools- Group #6694 7.2011 MAXIMUM BENEFIT Calendar Year Orthodontic Lifetime CALENDAR YEAR DEDUCTIBLE WHO CAN BE COVERED
More informationFor all eligible employees of Louisiana Riverboat Gaming Partnership dba Diamond Jacks Casino - Bossier City, Policy # All Eligible Employees
Dental insurance Benefit Highlights For all eligible employees of Louisiana Riverboat Gaming Partnership dba Diamond Jacks Casino - Bossier City, Policy # 902360 All Eligible Employees Effective date:
More information2017 FAQs. Dental Plan. Frequently Asked Questions from employees
2017 FAQs Dental Plan Frequently Asked Questions from employees September 2016 Dental plan Questions we ve heard our employees ask Here are some commonly asked questions about the Dental plan that our
More informationDental Benefits Options For State, Education & Local Government Employees
2016 2017 Dental Benefits Options For State, Education & Local Government Employees Option 1: Delta Dental PPO* Benefit Plan Delta Dental PPO Network Delta Dental Premier Network OR Non-Participating Dentist
More informationWe are BEST. Real People Rapid Claims Payment Great Service
Group Dental Plans We are BEST Real People Rapid Claims Payment Great Service BEST Life has been providing dental benefits to individuals, families and employers for more than 45 years with quality plans
More information2017 Dental Options BALTIMORE CITY PUBLIC SCHOOLS. Baltimore City Public Schools 2017 Dental Options C1
2017 Dental Options BALTIMORE CITY PUBLIC SCHOOLS Baltimore City Public Schools 2017 Dental Options C1 Table of Contents Important Information for 2017... 1 Dental HMO (DHMO)... 2 Preferred Dental PPO
More informationDental POS Benefit Summary
Policyholder: UC Postdoctoral Scholar Dental POS Benefit Summary Effective date: 01/01/2019 This chart provides you a brief summary of the key benefits of the dental coverage available from Principal Life
More information2018 Presbyterian Health Plan Federal Employee Dental & Vision Options
2018 Presbyterian Health Plan Federal Employee Dental & Vision Options For more information: 1804 Juan Tabo NE, Suite A, Albuquerque, NM 87112 888 862 8659 505 237 1501 benefitsource.org These benefits
More informationYour Delta Dental Program
Good oral health starts with knowledge. Smart plans for smart mouths. Your Delta Dental Program With your dental benefit program, you are free to go to any licensed dentist. However, you will save the
More informationDental Blue Program 2
SUMMARY OF BENEFITS Dental Blue Program 2 (with Orthodontics) Medium Option Massachusetts Bankers Association Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue
More informationDanJack Enterprises, Inc., d/b/a Business Resource Services (BRS) FUSION Highlight Sheet
Plan 1 Effective Date: 1/1/2019 FUSION: THE ULTIMATE CHOICE SM combines dental and eye care benefits in one easy-to-administer plan. This plan combines the annual maximum between the dental and eye care
More informationDental Benefits. Glossary. Delta Dental of Virginia DeltaDentalVA.com 1
Dental Benefits Glossary Delta Dental of Virginia DeltaDentalVA.com 1 Table of Contents Dental Benefits Terms... 4 16 A Annual Maximum... 5 B Balance Billing... 5 Benefit Year... 5 Benefit Levels... 6
More informationBaltimore City Public Schools 2013 Dental Options
Baltimore City Public Schools 2013 Dental Options Baltimore City Public Schools Important Phone Numbers for 2013 DHMO Customer Service (410) 847-9060 or (888) 833-8464 DHMO Mailing Address The Dental Network
More informationAffordable dental plan options for Blue Shield members
Affordable dental plan options for Blue Shield members January 1 December 31, 2018 Blue Shield offers two optional supplemental dental plans to Blue Shield 65 Plus SM (HMO), Blue Shield 65 Plus Choice
More informationDental Blue Program 2. Summary of Benefits. Amherst College
Dental Blue Program 2 Summary of Benefits Amherst College Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association Dental Blue Program 2 Preventive
More informationKaiser Permanente and Delta Dental
Kaiser Permanente and Delta Dental Dental Program for Kaiser Permanente FEHBP Enrollees You must be a Kaiser Permanente FEHBP enrollee to participate in the dental plan. Kaiser Permanente and Delta Dental
More informationTHE CALIFORNIA STATE UNIVERSITY DENTAL PROGRAM OVERVIEW Plan Year: January 1, 2016 December 31, 2016
THE CALIFORNIA STATE UNIVERSITY DENTAL PROGRAM OVERVIEW Plan Year: January 1, 2016 December 31, 2016 The California State University Dental Program consists of two types of plans: Delta Dental PPO and
More informationTHE CALIFORNIA STATE UNIVERSITY DENTAL PROGRAM OVERVIEW Plan Year: January 1, 2017 December 31, 2017
THE CALIFORNIA STATE UNIVERSITY DENTAL PROGRAM OVERVIEW Plan Year: January 1, 2017 December 31, 2017 The California State University Dental Program consists of two types of plans: Delta Dental PPO and
More informationIndividual/Family Dental Program
Individual/Family Dental Program Disclosure Form/Contract Provided by: All Aboard Benefits 800-462-2322 Ext. 1001 mike@allaboardbenefits.net www.allaboardbenefits.net Delta Dental Insurance Company provides
More informationDental POS Benefit Summary
Dental POS Benefit Summary PFG HC Dental 13 Predetermination of Benefits: Before treatment begins for inlays, onlays, single crowns, prosthetics, periodontics and oral surgery, you may file a dental treatment
More informationDELTA DENTAL OF OKLAHOMA
DELTA DENTAL OF OKLAHOMA STATE, EDUCATION & LOCAL GOVERNMENT EMPLOYEES DENTAL BENEFITS OPTIONS 2019 OUR STANDARD IS TO EXCEED YOUR EXPECTATIONS WE DELIVER A SUPERIOR CUSTOMER EXPERIENCE DDOK DOES NOT DENY
More informationYour Dental Benefits. The Local Choice Dental Benefits Program
Your Dental Benefits The Local Choice Dental Benefits Program Welcome to Delta Dental of Virginia In addition to the largest network of dentists in Virginia* and valuable benefits that help keep your out-of-pocket
More informationWhy do you need a dental plan?
Prepared for Comal County Guardian Group Plan Number 00406388 Why do you need a dental plan? 1 SAVE MONEY The average family spends $1353 each year on dental services, and twice that if children need braces.
More informationGood news about dental benefits for employees of. LCMC Health
Dental PPO Good news about dental benefits for employees of LCMC Health Why is dental health so important? Regular dental care does more than just improve smiles. Along with good oral hygiene, it can help
More informationDelta Dental EPO City & County of Denver Group #6791 EPO
MAXIMUM BENEFIT - Calendar Year Maximum Delta Dental EPO City & County of Denver Group #6791 EPO Unlimited See copayment schedule for additional details. Orthodontic Lifetime Unlimited See copayment schedule
More informationInsurance Plan. Dental Program Information. An Employer s Guide for the Manufacturer & Business Association Group Dental Insurance Program.
Insurance Plan Program Information An Employer s Guide for the Manufacturer & Business Association Group Insurance Program. Included in this bulletin is information on the following subjects: Premium Rates
More informationState of New Mexico Group Dental Benefits Plan
State of New Mexico Group Dental Benefits Plan Administered by Delta Dental of New Mexico Plan Year: January 1 December 31, 2018 Dental Networks Overview PPONew Mexico Delta Dental PPO Find a Dentist In
More informationDefinitions. Administrator. Benefits. Client. Contract Dentist. Contract Orthodontist. Contract Specialist. Copayment. Dentist. Eligible Dependent
Definitions Administrator Benefits Client Contract Dentist Contract Orthodontist Contract Specialist Copayment Dentist Eligible Dependent Eligible Employee Emergency Services Enrollee Full-Time Student
More informationOffering State of Florida employees benefit options
Offering State of Florida employees... 2014 benefit options NO CHANGE TO YOUR PREMIUMS FOR 2014! Two dental plans to choose from Look at these features! Indemnity with PPO Insured Plan/ Freedom Advance
More informationRetiree Dental Open Enrollment
Retiree Dental Open Enrollment November 1 December 15, 2017 Open Enrollment Fact Sheet Delta Dental Information Sheet Delta Dental Enrollment Form Delta Dental Direct Debit Application Retiree Dental Plan
More informationDominion Dental Services
Dominion Dental Services Plan 603X Presented by Professional Benefit Administrators 1 (800) 578-2082 SUMMARY OF BENEFITS AND COPAYMENTS Enrollee pays DIAGNOSTIC Office Visit/Infectious Disease Control.....$
More informationDENTAL PLAN INFORMATION
County of Kern DENTAL PLAN INFORMATION FOR PERMANENT EMPLOYEES Independence PPO Dental LIBERTY Cobalt Plus DHMO Dental Administered by LIBERTY Dental Plan of California 1(888) 273-3179 www.libertydentalplan.com/countyofkern
More informationDELTA DENTAL PPO SUMMARY OF BENEFITS FOR COVERED EMPLOYEES OF: County of Dane. (See Dental Benefit Handbook for definitions of capitalized terms.
DELTA DENTAL PPO SUMMARY OF BENEFITS FOR COVERED EMPLOYEES OF: County of Dane (See Dental Benefit Handbook for definitions of capitalized terms.) GROUP NUMBER: 00704-00000 EFFECTIVE DATE OF PROGRAM: January
More informationOffering State of Florida employees...
Offering State of Florida employees... 2016 benefit options Two dental plans to choose from Look at these features! Indemnity with PPO Insured Plan/ Freedom Advance (People First Plan Code: 4074) Freedom
More informationDental Options 2018 BALTIMORE CITY PUBLIC SCHOOLS
Dental Options 2018 BALTIMORE CITY PUBLIC SCHOOLS Contents Important Information for 2018... 1 Dental HMO (DHMO) Dental Plan... 2 Preferred Dental PPO (DPPO) Dental Plan... 3 Summary of Dental PPO Benefits...
More informationLincoln County School District
Lincoln County School District Delta Dental will be your new dental benefits provider effective July 1, 2016. Delta Dental has two networks of participating providers: Delta PPO & Delta Premier. Please
More informationEligibility and Enrollment
Eligibility and Enrollment Retirees receiving a monthly age and service or disability benefit may only enroll Legal spouse Must have a valid marriage certificate. Child(ren) This must be a participant
More informationOpen/Switch Enrollment 2017
State of New Mexico Group Benefits Plan Administered by Delta Dental of New Mexico Open/Switch Enrollment 2017 Plan Year: January 1 December 31, 2017 Dental Networks Overview PPONew Mexico Delta Dental
More informationIII. Dental Program Table of Contents
III. Dental Program Table of Contents About This Section...1 An Overview of Your Dental Program Options...2 Delta Dental...3 Preventive/Diagnostic Care...3 Basic Restorative Care...3 Major Restorative
More informationChoice, Service, Savings. To help you enroll, the following pages outline your company's dental plan and address any questions you may have.
Dental Plan Design for: San Jose Convention & Visitors Bureau Effective Date: March 1, 2000 Amendment Effective Date ± : November 1, 2017 Date Prepared: January 4, 2018 Choice, Service, Savings. To help
More informationOregon Association of Realtors Dental Highlight Sheet
Plan 1: Dental Plan Summary Effective Date: 1/1/2019 Plan Benefit Type 1 100% Type 2 80% Type 3 50% Deductible $50/Calendar Year Type 2 & 3 Waived Type 1 $150/family Maximum (per person) $1,000 per calendar
More informationFor all eligible employees of Maricopa County Community College District, Policy # All Eligible Employees
DHMO Dental Benefit Highlights For all eligible employees of Maricopa County Community College District, Policy #907728 All Eligible Employees Effective date: July 1, 2018 This dental plan can help lower
More informationA DENTAL PLAN THAT BALANCES CHOICE & SAVINGS
A DENTAL PLAN THAT BALANCES CHOICE & SAVINGS GuideStone s Choice Dental Plan with the Total Cigna DPPO Network The Total Cigna Dental PPO (DPPO) network makes it easy to help protect your health and your
More informationDelta Dental EPO City & County of Denver Group #6791 EPO
MAXIMUM BENEFIT - Calendar Year Maximum Delta Dental EPO City & County of Denver Group #6791 EPO Unlimited See copayment schedule for additional details. Orthodontic Lifetime Unlimited See copayment schedule
More informationDeltaCare USA CAA18. Dental Health Care Program for Eligible Employees and Dependents. Combined Evidence of Coverage and Disclosure Form
DeltaCare USA Dental Health Care Program for Eligible Employees and Dependents CAA18 Combined Evidence of Coverage and Disclosure Form Provided by: Delta Dental of California 12898 Towne Center Drive Cerritos,
More informationNon-voluntarydental (2-9) Kansas
Non-voluntarydental (2-9) Option 3 PPO Max 1000 Option 5 PPO 1500 Option 6 PPO 2000 Option 7 Aetna Dental Preventive Care PPO Max 100/80/50 PPO 100/80/50 PPO 100/80/50 PPO Max Plan 100/0/0 Annual deductible
More informationOpen/Switch Enrollment 2015
State of NM Group Benefits Plan Plan Year Jan-Dec 2015 Administered by of New Mexico Open/Switch Enrollment 2015 The State of NM Group Benefits Dental Plan Provider Network PPONew Mexico (In-Network New
More informationYour Guide to Healthy Smiles: Supplemental Dental Benefits
If you currently have supplemental dental coverage, you will need to enroll in a new plan during the It s Your Choice enrollment period to have coverage in 2019. See page 7 for more information. Your Guide
More informationEmployee Plan Information
Dental and Vision Premier Advantage FLEXIBLE DENTAL PLANS to meet your changing needs Employee Plan Information An option that allows you to move between the dental hmo and ppo plans as your needs change.
More informationPemberton Township BOE Group 86004
www.horizonblue.com Pemberton Township BOE Group 86004 Traditional Plan HDC Plan D Annual Deductible per person NONE Out-of-network Yes No Annual Maximum $1,000 NONE Ortho Maximum $1,000 $1,000 COVERED
More informationState of Tennessee. Prepaid Plan. Dental Benefit Option. Sponsored by the. State of Tennessee
State of Tennessee Prepaid Plan Dental Benefit Option Sponsored by the State of Tennessee 2011 Products and services marketed by Assurant Employee Benefits are underwritten and/or provided by Union Security
More informationAetna Dental presents A Dental Benefit Summary for Florida Voluntary Option 2; Freedom-of-Choice; w/ortho DMO
Aetna Dental presents A Dental Benefit Summary for Florida Voluntary Option 2; Freedom-of-Choice; w/ortho DMO PPO Max Annual Deductible* Individual None $75 Family None $225 Preventive Service Copay/Covered
More informationPLAN OPTION 1. Network Select Plan. Out-of-Network % of R&C Fee **
Harvest Management Sub LLC. dba Holiday Retirement Dental Metropolitan Life Insurance Company Network: PDP Coverage Type Type A: Preventive (cleanings, exams, X-rays) Type B: Basic (fillings, extractions)
More information23XX2293 R3/08 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company
www.bcbsla.com 23XX2293 R3/08 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company 1 Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc. are
More informationHumana Dental Traditional Preferred 14
SGB0169A Humana Dental Traditional Preferred 14 LOUISIANA Xavier University of Louisiana-Base Calendar-year deductible (excludes orthodontia services) If you use an IN-NETWORK dentist If you use an OUT-OF-NETWORK
More informationPlans for Small Businesses
Plans for Small Businesses CALIFORNIA 208 Delta Dental SM Why choose Delta Dental? It s simple, really. Employees are a small business owner s greatest investment, and it s difficult to balance protecting
More informationWelcome to Arkansas Blue Cross and Blue Shield Dental Plan
Welcome to Arkansas Blue Cross and Blue Shield Dental Plan University of Arkansas System Dental Program Beginning January 1, 2018, the University of Arkansas System dental plan will be administered by
More informationDeltaCare. USA provided by Alpha Dental Programs, Inc. Quality. Predictable costs. Convenience
7.6.15 DeltaCare USA provided by Alpha Dental Programs, Inc. We ll do whatever it takes and then some. Find a DeltaCare USA dentist Select from among the many conveniently located DeltaCare USA contracted
More informationyou can smile more with Horizon Dental Dental Plan Guide Individual and Family Plans HorizonBlue.com/ShopDental
you can smile more with Horizon Dental. 2017 Dental Plan Guide Individual and Family Plans HorizonBlue.com/ShopDental 2017 Dental Plan Guides Combine dental with health coverage to feel better and smile
More informationNon-voluntary dental (2-9) Colorado
Non-voluntary dental (2-9) Option 1 DMO Access Option 2 Freedom-of-Choice Monthly selection between the DMO and PPO Option 3 PPO Max 1000 Option 4 Active PPO Plan 42 DMO 100/90/60 PPO 100/70/40 PPO Max
More informationNon-voluntary dental (2-9) Nevada
Non-voluntary dental (2-9) Option 1 DMO Access Option 2 Preventive Care PPO Option 3 PPO 1000 Option 4 PPO Active Option 5 PPO 2000 Plan 42 PPO 100/0/0 PPO 100/50/50 Preferred 100/80/50 Non-Preferred 80/60/50
More informationNon-voluntary dental (2-9) Texas
Non-voluntary dental (2-9) Option 1 DMO Access Option 2 DMO Option 3 Freedom-of-Choice Monthly selection between the DMO and the PDN Plan Option 4 PDN Max Option 5 PDN 1500 DMO Copay 42 DMO 100/90/60 DMO
More informationRe: Health and Dental Insurance
Five Colleges, Inc. ~ Memorandum To: All Benefited s From: Barbara Lucey Date: November, 2017 Re: Health and Dental Insurance We are staying with Harvard Pilgrim as our health insurance carrier this year.
More informationAetna Dental presents A Dental Benefit Summary for Florida Option 3; Freedom-of-Choice; w/ortho DMO
Aetna Dental presents A Dental Benefit Summary for Florida Option 3; Freedom-of-Choice; w/ortho DMO PPO Annual Deductible* Individual None $50 Family None $150 Preventive Service Covered Percent 100% 100%
More informationHealthPartners State of Minnesota Dental Plan Appendix
HealthPartners State of Minnesota Dental Plan Appendix Effective Date: The later of the effective date of your Employer s Dental Benefit Plan or your effective date of coverage under the Plan. See Section
More informationIt s easy to find a network dentist or specialist.
Smile! It s easy to find a network dentist or specialist. Finding a Cigna Dental PPO (DPPO) network dentist or specialist is quick and easy whether you prefer searching online or speaking to a customer
More informationDental Benefit Summary
DMO Passive PPO Annual Deductible* Individual None $75 Family None $225 Preventive Service Covered Percent 100% 80% Basic Service Covered Percent 100% 50% Major Service Covered Percent 60% 50% Annual Benefit
More informationChoosing your plan. County of Santa Barbara. We ll do whatever it takes and then some. Your Two Delta Dental Plan Options
County of Santa Barbara Choosing your plan Your Two Delta Dental Plan Options The choice is yours. When it comes to dental health, you want benefits that provide you with the best balance of value and
More informationDental plan premiums for Oregon
Dental plan premiums for Oregon These premiums apply to members who live anywhere in Oregon. Plan name *Age 60+ PPO SM $40 Exclusive PPO SM $44 Premiums effective Jan. 1, 2018, through Dec. 31, 2018 *
More informationHIGH OPTION PLAN for Eligible Part and Full-Time Employees Excluding Employees Residing in Mississippi or Texas. Out-of-Network.
Dental Insurance Plan Summary Excluding Employees Residing in Mississippi or Texas Network: PDP Plus HIGH OPTION PLAN for Eligible Part and Full-Time Employees Excluding Employees Residing in Mississippi
More informationSUMMARY OF BENEFITS PLAN INFORMATION
SUMMARY OF BENEFITS PLAN INFORMATION Cigna Dental 1000 Plan With Cigna there is more to smile about. You get flexible benefits and premium levels to meet your needs and budget, plus: Access to over 89,000
More informationSUMMARY OF BENEFITS PLAN INFORMATION
SUMMARY OF BENEFITS PLAN INFORMATION Cigna Dental 1500 Plan With Cigna there is more to smile about. You get flexible benefits and premium levels to meet your needs and budget, plus: Access to over 89,000
More informationSUMMARY OF BENEFITS PLAN INFORMATION
SUMMARY OF BENEFITS PLAN INFORMATION Cigna Dental 1000 Plan With Cigna there is more to smile about. You get flexible benefits and premium levels to meet your needs and budget, plus: Access to over 89,000
More informationDental Plans for All Employers
Delta Dental of Nebraska 2018 Plans: Delta Dental PPO plus Premier - Dental Access Delta Dental PPO plus Premier - Millennium Choice Delta Dental PPO plus Premier - Dental Flex Delta Dental PPO plus Premier
More informationDeductible 3 Individual $50 $50. Annual Maximum Benefit: Per Individual $2,000 $2,000
Dental Plan Design for: Ector County Independent School District Original Plan Effective Date: January 1, 2018 Network: PDP Plus The Preferred Dentist Program was designed to help you get the dental care
More informationPROOF. Group Dental Plan For the State of Florida Employees and Their Families, 2018 People First Plan Codes 4021, 4022 and 4023
Group Dental Plan For the State of Florida Employees and Their Families, 2018 People First Plan Codes 4021, 4022 and 4023 Dental benefits are our specialty, and we work hard to make a plan that works for
More informationDELTA DENTAL PPO sm AGREEMENT SUPPLEMENT TO DELTA DENTAL PREMIER PARTICIPATING DENTIST S AGREEMENT
DELTA DENTAL PPO sm AGREEMENT SUPPLEMENT TO DELTA DENTAL PREMIER PARTICIPATING DENTIST S AGREEMENT This agreement (the "Supplement") supplements the Delta Dental Premier Participating Dentist s Agreement
More informationYour Dental and Vision Benefits Beaver Motors
OPEN ENROLLMENT 2017 Summary of Benefits Your Dental and Vision Benefits Beaver Motors Relationships are built on trust. Respect for an individual s privacy goes a long way toward building trust. Humana
More informationPremera DentalBlueTM FOR ALASKA GROUPS WITH 2+ EMPLOYEES
Premera DentalBlueTM FOR ALASKA GROUPS WITH 2+ EMPLOYEES January 2015 Dental product options that let you build a comprehensive benefits package Premera Blue Cross Blue Shield of Alaska offers a range
More information