|
|
Name of Plan |
|
|
Delta Dental Plan I |
Delta Dental Plan II |
Delta Dental Plan III |
Delta Dental Plan IV |
No. of Employees Required on Plan These plans have strict participation requirements, but can take groups as small as 2 people. Please check with your Bryton benefits representative for specific participation requirements. |
| Type I Preventive Procedures |
Deductible
You Pay |
-0- -0- |
-0- -0- |
-0- 20% of charges |
-0- 20% of charges |
| Type II Routine Procedures |
Waiting Period
Deductible
You Pay |
None $25 Per Year 20% of charges |
None $25 Per Year 20% of charges |
None $25 Per Year 50% of charges |
None $25 Per Year 50% of charges |
| Type III Major Procedures |
Waiting Period
Deductible
You Pay |
None $25 Per Year 50% of charges |
None $25 Per Year 50% of charges |
None $25 Per Year 50% of charges |
None $25 Per Year 50% of charges |
| Type IV Orthodontia |
Waiting Period
Deductible
You Pay |
None -0- 50% of charges |
NOT COVERED |
None -0- 50% of charges |
NOT COVERED |
Maximum annual dollar benefit per person: Plans I & II have a $2,000 per person per year maximum (Plan I has a separate lifetime orthodontia benefit of $1,000)
Plans III and IV have a $1,500 per person per year maximum (Plan III has a separate lifetime orthodontia benefit of $1,000)
(This chart is a summary of benefits. For a detailed explanation of benefits, please refer to any appropriate brochures and the policies themselves.)