Delta Dental of WI
PO Box 828
Stevens Point, WI 54481
800.236.3712
http://www.deltadentalwi.com
Eligible Employee:
Any employee hired to work at least 30 hours per week is eligible to participate in a dental insurance plan. Employees hired to work at least 30 hours per week, but less than full-time, will have prorated premium costs.
Benefit Period:
January through December
Maximum Benefit Per Person Per Benefit Period Except Orthodontic Benefits:
$2,000
Maximum Benefit Per Person Per Lifetime For Orthodontic Benefits:
$2,000
Benefit Period Deductible Per Person:
$0
Group Dental Policy Benefit Summary (Benefit and Coverage Percent):
Periodical Oral Examinations 100%
Bitewing X-rays 100%
Prophylaxes 100%
Fluoride Applications 100%
Sealant 100%
Diagnostic X-rays 100%
Pulp Vitality Tests 100%
Office Visits or Consultations 100%
Fillings 80%
Anesthesia 80%
Extraction of Teeth 80%
Oral Surgery 80%
Stainless Steel Crowns 80%
Space Maintainers 80%
Pulpotomies and Root Canal Treatment. 80%
Periodontal Treatment 80%
Denture Repair 80%
Occlusal Adjustments ($100 lifetime maximum) 100%
Bruxism Appliances 80%
Onlays, Porcelain Crowns, and Cast Crowns 80%
Dentures, Bridgework, and Implants 80%
Orthodontia to Age 19