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Test Announcement

 

Wesleyan University – Group # 6507

Delta Dental Premier  

 

 

Calendar Year Deductible

 

       Per Person

$50

       Family Aggregate Maximum

$150

 

 

 

Plan Pays:

Preventive & Diagnostic (No Deductible)

100%

         Exams, Cleanings, Bitewing X-Rays (2 per calendar year per person)

 

         Fluoride Treatment (1 per calendar year for children to age 19)

 

         Space Maintainers

 

 

 

Remaining Basic (After Deductible)

80%

         Fillings, Extractions, Root Canals (Endodontics)

 

         Periodontal, Oral Surgery

 

         Sealants (To age 14)

 

 

 

Crowns & Prosthodontics (After Deductible)

50%

         Crowns, Gold Restorations

 

         Bridgework, Full & Partial Dentures

 

         Repair of Dentures

 

 

 

Calendar Year Maximum (Per Person)

$1,200

 

 

Orthodontia (Dependent Children Only)

 

       Coinsurance

50%

       Lifetime Maximum

$1,500

 Dependent children are covered to age 19 (25 if enrolled as a full time student in an accredited school or university.)

 

 Delta Dental has over 2,500+ participating dental offices in Connecticut and 145,000+ participating offices nationwide.  You may use any fully licensed dentist under this plan.  Participating dentists will be paid directly by Delta for covered services.  Non-participating dentists will bill you directly, and Delta may make claim payment directly to you.  You will maximize benefits and reduce paperwork by using a Delta participating dentist.

If you do not have a dentist, you may obtain a current listing of participating dentists in any area, by calling 1-800 DELTA OK (1-800-335-8265).  Provide your zip code to the representative and a directory for that area will be mailed to your home.  If you have Internet access, you may also visit our website at deltadentalnj.com to locate participating dentists. 

At the time of your first appointment, tell the dentist that you are covered under this program and provide your group number and social security number.  Your dependents, if covered, should provide the employee’s social security number. 

Claim questions and other information needs should be directed to Delta’s benefits services department at 1-800-452-9310.

 

This overview contains a general description of your dental care program for your use as a convenient reference.  Complete details of your program appear in the group contract between your plan sponsor and Delta Dental Plan of New Jersey, Inc. which governs the benefits and operation of your program.  The group contract would control if there should be any inconsistency or difference between its provisions and the information in this overview.