Dental Benefits
Lhoist North America offers Delta Dental PPO coverage with biweekly pre-tax premiums and in-network and out-of-network benefit levels.
Dental Benefits
Premiums - Biweekly contributions
| Coverage Tier | Biweekly Contribution |
|---|---|
| Employee Only | $3.52 |
| Employee + Spouse | $7.43 |
| Employee + Child(ren) | $6.02 |
| Employee + Family | $11.04 |
Employee Only
- Biweekly Contribution
- $3.52
Employee + Spouse
- Biweekly Contribution
- $7.43
Employee + Child(ren)
- Biweekly Contribution
- $6.02
Employee + Family
- Biweekly Contribution
- $11.04
Covered Services
| Service | In-Network | Out-of-Network |
|---|---|---|
| Annual Deductible - Individual | $50 | $50 |
| Annual Deductible - Family | $150 | $150 |
| Annual Maximum - Per Person | $2,000 | $2,000 |
| Preventive Services | 100% | 100% |
| Basic Services | 80%* | 80%* |
| Major Services | 50%* | 50%* |
| Orthodontics Dependent Child(ren) Only – Up to Age 20 | 50% | 50% |
| Orthodontic Lifetime Maximum | $2,000 | $2,000 |
Annual Deductible - Individual
- In-Network
- $50
- Out-of-Network
- $50
Annual Deductible - Family
- In-Network
- $150
- Out-of-Network
- $150
Annual Maximum - Per Person
- In-Network
- $2,000
- Out-of-Network
- $2,000
Preventive Services
- In-Network
- 100%
- Out-of-Network
- 100%
Basic Services
- In-Network
- 80%*
- Out-of-Network
- 80%*
Major Services
- In-Network
- 50%*
- Out-of-Network
- 50%*
Orthodontics Dependent Child(ren) Only – Up to Age 20
- In-Network
- 50%
- Out-of-Network
- 50%
Orthodontic Lifetime Maximum
- In-Network
- $2,000
- Out-of-Network
- $2,000
- *After deductible
Important Notes
- If your dentist doesn’t participate in your plan’s network, your out-of-pocket costs will be higher, and you are subject to any charges beyond the Reasonable and Customary (R&C).
- To find a network dentist, visit Delta Dental at www.deltadentalins.com.
- Oral health is linked to your overall health — keeping your mouth healthy can protect you from cardiovascular disease, pregnancy complications, and pneumonia.