Any employee hired to work at least 20 hours per week is eligible to participate in the dental insurance plan. Employees who work at least 20 hours per week, but less than full-time, will have prorated premium costs. Open enrollment for dental insurance for existing employees is each July 1st. 2024-25 Insurance Premiums.
Maximum Benefit Per Person Per Benefit Period (January through December) Except Orthodontic Benefits: $1,000
Maximum Benefit Per Person Per Lifetime For Orthodontic Benefits: $1,500
Benefit Period Deductible Per Person: $0
DeForest Group No: 97316 |
SCHEDULE OF BENEFITS |
Payable at: |
Special Plan Provisions |
CheckUp Plus = Diagnostic & Preventive services are not applied to annual maximum. |
100% |
Diagnostic & Preventive |
Periodical Oral Examinations (two during 12 month period) |
100% |
|
Cleaning / Prophylaxes (two during 12 month period) |
100% |
|
Bitewing X Rays (two during 12 month period) |
100% |
|
Fluoride Treatment (for covered dependents under the age 19) |
100% |
|
Sealants (once every 5 years to covered dependents under age 17) |
100% |
|
Diagnostic X-Rays |
100% |
Basic Services |
Fillings |
100% |
|
Extraction of Teeth |
100% |
|
Oral Surgery |
100% |
|
Space Maintainers |
100% |
|
Periodontic Treatment |
100% |
|
Pulpotomies and Root Canal Treatment |
100% |
Major Services |
Onlays, Porcelain Crowns, and Cast Crowns |
50% |
|
Dentures, Bridgework, and Implants |
50% |
The above summary provides information about reimbursement limits that apply to your dental insurance plan. Please review the Delta Dental Handbook or visit the Delta Website for specific exclusions and limitations of the plan. You can also set up online/mobile access to your dental information. In addition, the Delta dental plan includes a Vision Care Discount Program that can be used for purchase of frames and lenses. You can also contact the insurance carrier at:
Delta Dental
PO Box 828
Stevens Point, WI 54481
(800) 236-3712
|