Page 15 - Willscot I Mobile Mini Open Enrollment Guide

Dental Insurance
Research shows there may be a connection between poor dental health and serious health conditions. Regular dental check-ups and good oral hygiene are an essential part of your general health and well-being.
Key Words to Know:
The service examples below are not guarantees of coverage; refer to Plan Documents to confirm covered services.
Annual Maximum Benefit: Maximum total amount the plan will pay during the plan year
Basic Services: Services such as basic restorations, some oral surgery, endodontics and periodontics Deductible: The amount you pay before the plan begins to pay
Major Services: Services such as crowns, dentures, implants and some oral surgery
Orthodontia: Straightening or moving misaligned teeth and/or jaws with braces and/or surgery Preventive Services: Services designed to prevent or diagnose dental conditions, including oral evaluations, routine cleanings, X-rays, fluoride treatments and sealants
Review Your Dental Plan Options
Delta Dental
(PPO plus Premier)
Dental Plan Summary
The following benefits are included in your plan options. Unless otherwise noted, benefits are per insured person and after deductible.
Basic Plus
Enhanced with Orthodontia
Annual Deductible
Individual
Annual Maximum
Dental Benefit Coverage
Preventive Services
Major Services
Orthodontia
Benefit Coverage Eligibility
*Deductible does not apply
$50
$50
Family
$150
$150
Benefit Maximum
$1,000 $2,000
Plan pays 100%* Plan pays 100%* Plan pays 50% Plan pays 50% Not Covered Plan pays 50%
Basic Services
Plan pays 70%
Plan pays 80%
Lifetime Maximum
Not Covered
$2,500
Not Covered
Eligible children to age 26
In-Network and Out-of-Network benefit provisions are the same, but may be applied differently for Out-of- Network services. Please refer to Plan Documents for additional details.
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