The Village of Ashwaubenon partners with Delta Dental to offer you a voluntary, employee paid dental plan. By going to an in-network dentist you will realize a greater cost savings.
Benefit Summary
| Benefit Plan Design | PPO & Premier
Dentists | Out of network |
Individual Annual Maximum:
Diagnostic & Preventive including exams, X-rays and regular cleaning do not apply to the Annual Maximum | $1,200 | $1,200 |
Annual Deductible:
• Per Person
• Per Family
| $0
$0 | $0
$0 |
Diagnostic and Preventive Services:
• Exams, Cleanings, X-rays, Fluoride Treatments
| 100% | 100% |
Basic Restorative Procedures:
• Fillings, Endodontics, Periodontics, Extractions
| 80% | 80% |
Major Restorative Services:
• Crowns, Inlays, Onlays, Repairs to bridges and dentures, Bridges, Dentures, Implants
| 80% | 80% |
Orthodontic Services:
• Per employee, spouse & dependent child to age 26
| 75% to a lifetime max. of $1,500 | 75% to a lifetime max. of $1,500 |
In-Network Advantages
- Delta Dental PPO network offers the greatest savings and claims are processed for you
- Delta Dental Premier network has the largest dentist network, but the savings to you are as significant as the PPO network
- Claims are directly paid to the provider and no balance billing can occur under the PPO and Premier networks
- Benefit dollars go farther under the PPO and Premier networks due to lower costs
- Claim reimbursements for an out-of-network dentist will be sent to you and not the provider
Finding a network dentist
Evidence-Based Integrated Care Plan
- EBICP provides additional preventive benefits for those with who need them most:
- Cancer therapy
- Suppressed immune system
- Periodontal disease
- High-risk cardia conditions
- Kidney failure or dialysis
- Diabetes
- Pregnancy
- Enroll online at deltadentalwi.com, or by calling 1-888-360-3510
