Dental | Intact Insurance Specialty Solutions Benefits

DENTAL

Delta Dental of Minnesota

Dental

Group ID #100417

The dental plan carrier is Delta Dental and Intact offers two dental plans, the Basic Dental and Enhanced Dental plan. Each plan has differing levels of coverage, so you can choose depending on your needs.

Within each Delta Dental plan there are two networks that can be utilized. The Delta Dental PPO network will give you the best possible discounts, but the Delta Dental Premier Network is the largest dentist network in the country.

Plan Comparison

Benefit	Basic Dental	Enhanced Dental
	In-network / Out-of-network	In-network / Out-of-network
Annual Deductible (Individual / Family)	$50 / $150	$25 / $75
Coinsurance for Preventive Services	Plan pays 100%	Plan pays 100%
Coinsurance for basic restorative services	Plan pays 50%	Plan pays 80%
Coinsurance for major restorative services	Plan pays 50%	Plan pays 50%
Annual Plan Maximum	$1,500	$2,500
Orthodontia coinsurance	N/A	Plan pays 80%
Orthodontia lifetime maximum	N/A	$1,500

Employee Contribution

Salary Band	Bi-Weekly Contributions
1. < $50,000	Basic	Enhanced
Employee Only	$5.81	$15.59
Employee + Spouse	$14.39	$35.40
Employee + Child(ren)	$11.33	$30.38
Family	$19.14	$48.95
2. $50,001 - $100,000	Basic	Enhanced
Employee Only	$6.14	$16.45
Employee + Spouse	$15.19	$37.36
Employee + Child(ren)	$11.96	$32.07
Family	$20.21	$51.67
3. $100,001 - 150,000	Basic	Enhanced
Employee Only	$6.46	$17.32
Employee + Spouse	$15.99	$39.33
Employee + Child(ren)	$12.59	$33.76
Family	$21.27	$54.39
4. $150,001 - 200,000	Basic	Enhanced
Employee Only	$7.04	$18.88
Employee + Spouse	$17.43	$42.87
Employee + Child(ren)	$13.72	$36.80
Family	$23.18	$59.29
5. $200,001 +	Basic	Enhanced
Employee Only	$7.43	$19.92
Employee + Spouse	$18.39	$45.23
Employee + Child(ren)	$14.48	$38.82
Family	$24.46	$62.55

Intact Insurance Specialty Solutions is the marketing brand for the insurance company subsidiaries of Intact Insurance Group USA LLC. Coverages may be underwritten by one of the following insurance companies: Atlantic Specialty Insurance Company, a New York insurer; Homeland Insurance Company of New York, a New York insurer; Homeland Insurance Company of Delaware, a Delaware insurer; OBI America Insurance Company, a Pennsylvania insurer; OBI National Insurance Company, a Pennsylvania insurer; or The Guarantee Company of North America USA, a Michigan insurer. Each of these insurers maintains its principal place of business at 605 Highway 169 N, Plymouth, MN 55441, except The Guarantee Company of North America USA, which is located at One Towne Square, Southfield, MI 48076. This material is intended as a general description of certain types of insurance coverages and services. Coverages and availability vary by state; exclusions and deductibles may apply. Please refer to your insurance policy or consult with your independent insurance advisor for information about coverages, terms and conditions. Some coverage may be written by a surplus lines insurer through a licensed surplus lines broker. Surplus lines insurers do not generally participate in state guaranty funds and insureds are therefore not protected by such funds.