Dental Contributions
Level of Coverage | Employee | Employee + Spouse | Employee + Children | Employee + Family |
---|---|---|---|---|
No Coverage | ($0.00) | N/A | N/A | N/A |
Delta Dental | $0 | $0 | $0 | $0 |
Dental Insurance (Available Nationally)
XYZ Companies offers employees access to affordable dental care through Delta Dental. Under the Delta Dental plan, you may go to any licensed provider for your dental needs. Out of network charges will be paid according to the maximum in-network allowance.Dental Insurance (Available Nationally)
The chart below lists the coverage amounts and limits for the Delta Dental Premier plan offered:
Summary | PPO/Premier Providers | Out-of-Network Providers |
---|---|---|
Annual Deductible (Class I, II and III expenses) | $00/$000 | $00/$000 |
Annual Benefit Maximum (Individual/Family) | $0000 | $0000 |
Type I - 2013 Diagnostic Preventive Oral Evaluations and Cleanings Fluoride Sealants Space Maintainers Bitewing X-Rays/Full Mouth X-Rays | 00% covered | 00% of maximum network allowance |
Type II - 2013 Basic Services Fillings Simple Extractions Palliative Services Endodontics (Root Canal) Surgical Extractions | 00% covered | 00% of maximum network allowance |
Type III - 2013 Major Services Crown/Bridge/Denture Repair Inlays/Onlays/Crowns Complete and Partial Dentures Fixed Bridgework | 00% covered | 00% of maximum network allowance |
Orthodontic Lifetime Maximum (per dependent child to age 19) | $00 after deductible ($000 max.) | $00 after deductible ($000 max.) |