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American Chemistry Council 2017 Summary of Benefits

Dental

Insurance

Delta Dental

www.deltadentalins.com

800-932-0783

The Council offers dental insurance through Delta Dental. Your dental coverage is effective on the first

day of the month coincident with or following your date of hire.

In-Network

Out of Network

Deductible

$0.00

$50.00

Cleanings

2 per year @ 100%

2 per year @ 100%

Basic Services

90%

80%

Major Services

60%

50%

Plan Year Maximum

$2,500

$2,500

Orthodontia is covered at 50% with a lifetime maximum of $2,500. This benefit is provided to both children

and adults. These pre-tax deductions are withheld from your paycheck on a bi-weekly basis.

Plan Options

Per Pay Period Deductions

Employee Only

$9.90

Employee Plus Child(ren)

$19.81

Employee Plus Spouse

$19.81

Family

$19.81