Dental – ACME

Dental Plan

With your dental benefit program, you can go to any licensed dentist. However, you will save the most money by visiting a dentist in the Delta Dental Premier network. Out-of-network dentists have not agreed to accept Delta Dental’s fees, which means they may bill for any charges over the allowed amount.

Delta Dental utilizes the Delta Dental PPO plus Premier network. Your benefits can be maximized by using an in-network provider.
Delta Dental includes additional cleanings and/or fluoride treatment to individuals with specific medication conditions that have oral health implications, called Evidence-Based Integrated Care. To utilize the coverage, you will need to enroll online through your Delta Dental account.
Delta Dental includes additional visits, consultations and/or exams for individuals an intellectual or developmental disability.

Dental	In-Network
Annual Deductible	$50/person; $150 per family
Annual Benefit Maximum	$1,500 per individual
Lifetime Orthodontia Maximum	$1,500 per individual
Plan Pays
Diagnostic & Preventive Care Oral evaluations, x-rays, cleanings, sealants, fluoride treatment (once per benefit year for children up to age 19)	100% covered Deductible waived, does not count towards annual benefit maximum.
Basic Services	Amalgam and resin fillings, oral surgery, endodontic, periodontics, general anesthesia
Major Services Resins, crowns, fixed, removable bridges, partial or full dentures, crown and bridge repairs, implants	You pay 50% after deductible
Orthodontics Child and Adult	You pay 50%

Dental Cost of Coverage

Employee Contributions (Bi Weekly 24 per yr)
Dental Plan
Employee	$20.88
Employee & Spouse	$46.64
Employee & Child(ren)	$43.32
Employee & Spouse & Child(ren) (Family)	$66.00