Dental
Atlantic Packaging offers a dental program through Delta Dental. The chart below is a brief outline of the plan. Please refer to the summary plan description for complete plan details.
While the coverage is the same in- and out-of-network, you will pay less out of pocket if you visit an in-network provider with Delta Dental.
Visit www.deltadentalnc.com to find a dentist in their network.
Cost of Coverage
| Employee Contributions | Monthly | Weekly |
|---|---|---|
| Employee | $30.37 | $7.01 |
| Employee & Spouse | $67.37 | $15.55 |
| Employee & Child(ren) | $65.02 | $15.00 |
| Employee & Family | $118.42 | $27.33 |
Coverage
| Delta Dental | In-Network Benefits | Out-of-Network Benefits | ||
|---|---|---|---|---|
| Annual Deductible | ||||
| Individual | $50 | $50 | ||
| Family | $150 | $150 | ||
| Waived for Preventive Care? | Yes | Yes | ||
| Annual Maximum | ||||
| Per Covered Person | $1,500 | $1,500 | ||
|
Diagnostic & Preventive* oral examination, cleaning, all x-rays, topical application of fluoride solution for dependent children up to age 19, space maintainers, sealants for children up to age 16 |
100% | 100% | ||
|
Basic extractions, fillings, oral surgery, lab services required for procedures, general anesthesia, endodontic and periodontal care |
80% | 80% | ||
|
Major crowns, inlays/onlays, bridges, dentures, implants |
50% | 50% | ||
|
Orthodontia (covered dependent children up to age 19) |
||||
| Benefit Percentage | 50% | 50% | ||
| Lifetime Maximum | $1,000 | $1,000 | ||
*Preventive Incentive – Diagnostic and Preventive Services do not count toward the annual maximum
Delta Dental Benefit Summary
PPO PLUS PREMIER
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NORTH CAROLINA
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