Jackson Family Wines is pleased to offer dental coverage through Delta Dental. You are not required to choose a Delta Dental PPO network dentist, but when you do, you will have lower out-of-pocket costs. Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists.
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Annual Deductible | $50 Individual/$150 Family | $50 Individual/$150 Family |
| Annual Benefit Maximum | $2,000 per person | $1,500 per person |
| Diagnostic & Preventive Care | Covered at 100% (deductible waived) | Covered at 100% (deductible waived) |
| Basic Care | 10% after deductible | 20% after deductible |
| Major Care | 40% after deductible | 50% after deductible |
| Orthodontics | (children & adults) 50% (deductible waived) up to $2,000 lifetime maximum per individual | (children & adults) 50% (deductible waived) up to $2,000 lifetime maximum per individual |
Find a Delta Dental PPO network dentist by visiting www.deltadentalins.com.
Click: “Find a dentist”
Select: “Delta Dental PPO” as your plan network
Enter: Options for your search such as state and ZIP code, dentist name, practice name, miles (radius) and type of dentist (specialty)
Delta
Plan# 1633
Phone: (800) 765-6003
www.deltadentalins.com
