Delta dental premier benefits summary

This is a summary of benefits. The information shown here is not a guarantee of payment. Refer to the Certificate of Coverage for the full plan terms.

The Certificate includes any limitations or exclusions not seen here. Services do not apply to the.

Follow our simple, three-step registration process and to our secure system to see your eligibility information and benefits details. Delta Dental Premier Family Enhanced. To maximize your dental benefits , we encourage you to visit a participating dentist.

Your out-of-pocket costs will be higher when you visit a non-participating dentist. Please refer to your Certificate of Coverage for further details. If there is any discrepancy between the information in this summary and the contract, it is the contract that will control. PPO Premier Out-of-network How to find an in-network dentist near you: 1.

Click on ‘Online Tools’ and use the ‘Find a Dentist’ tool. Non Participating Dentists: Members may be held liable for the difference between the dentist’s billed charge and the non-participating allowable. These services must be provided by a Dentist and must be necessary and customary under generally accepted dental practice standards. You don’t have to pay the entire bill and wait for reimbursement. We pay your dentist directly and send you an Explanation Of Benefits.

Please note, Kaiser Permanente Vision Benefits are included in the Medical coverage and can be found on the You can get this document in other languages, large print, braille or a format you prefer. Members are responsible for their copayment and deductible (if any) and charges for any non-covered services. Benefits will cease on the last day of the month in which the employee is terminated. Should any discrepancy arise, any such contract supersedes this illustration. The Dental Benefit Policy prevails if discrepancies are noted between this brochure and the Dental Benefit Policy.

SUMMARY OF DENTAL BENEFITS After you have satisfied the deductible, if any, your dental program pays the following percentages of the treatment cost, up to a maximum fee per procedure. The Harvard University dental plan provides a unique design with two Levels of coverage within one plan. Level provides coverage that meets most dental needs in a traditional dental benefit structure.

Your dependent children may be enrolled on both applications as well. Out of network charges will be paid according to the maximum in-network allowance.

Eligibility: 1st of the month following days of employment, must be a Full-Time employee with an FTE of. The Benefits of the Premier plan mirror the Adaptable plan. PROGRAM OF BENEFITS : DELTA DENTAL PPO – PLUS PREMIER. The benefits listed below are not a complete list. Limitations to benefits can be found in the Summary Plan Description.

Switching between incentive plans (or 5) and other non-incentive plans will have an effect on benefit level. Restorative If a tooth colored filling is used to restore posterior (back) teeth, benefits are limited to the amount paid for a silver filling. With a table of allowance plan, you know in advance exactly how much the plan covers for each dental service.

Annual Maximum $5per enrollee, per calendar year.