Delta Dental
Eskaton’s dental coverage provided through Delta Dental allows you to receive care from any
licensed dentist of your choice. Below is a summary of the key features and costs.
Dental and Vision Package
Coverage | Delta PPO Dentist | Delta Premier | Non Delta Dental |
|---|---|---|---|
| Deductible | $50 per person | ||
| Annula Max | $1,500 per person | ||
| Preventative (Exams, Cleaning, X Rays) | 100% (deductible waived) | ||
| Basic (Fillings, Root Canals) | 20% after deductible | 20% after deductible | 20% of UCR*after deductible |
| Major (Dentures, Crowns) | 20% after deductible | 20% after deductible | 20% of UCR*after deductible |
| Ortho (Adults & Children) lifetime maximum | $1,000 per person | 20% after deductible | 20% of UCR*after deductible |
| Orthodontics services | 50% up to $1,000 lifetime maximum per person | ||
*Out-of-network providers will be paid at usual, customary and reasonable (UCR) limits. You will be responsible for any charges in excess of UCR.
This is intended to be a guide. For a complete description, refer to the summary plan documents. If there is a discrepancy, the plan documents govern.
Coverage Tier | Employee Monthly Cost | Employee Biweekly Cost |
|---|---|---|
| Employee Only | $27.00 | $13.75 |
| Employee + One Dependent | $60.00 | $30.00 |
| Employee + Family | $105.00 | $52.50 |
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