"Exclusively for Chamber Members" - Delta Dental Plan Options
American Benefits Group currently
offers an outstanding group dental insurance program from Delta
Dental Plan of Massachusetts for Chamber of Commerce members.
Three plans
which offer different levels of coverage and very competitive
rates are available. DeltaPremier Plan A is offered to
employers with two or more participating employees, Plan B to
employers with ten or more participating employees, and Plan C with
twenty or more participants. This chart details the coverage
options and monthly premium rates through March 31, 2009.
For additional information, please contact Bob Cummings or Herb
Mayer at (413) 584-9923 .
Delta
Premier |
Plan
A |
Plan
B |
Plan C |
Type
I Services: Diagnostic/Preventative: Exams, Cleanings, X-rays, Floride Treatments, Sealants |
100% |
100% |
100% |
Deductable: |
None |
None |
None |
Type
II Services: Basic Restorative: Fillings, Oral Surgery, Periodontics, Endodontics, Prosthetic Maintenance, Emergency Dental Care |
80% |
80% |
80% |
Deductable: |
$50 Single |
$50 Single |
$50 Single |
Type
III Services: Major Restorative: Prosthodontics, Bridges, Dentures and Crowns |
N/A |
50% |
Orthodontic Services: |
N/A |
N/A |
Deductable: |
$50 Single |
Benefit Maxiumum
Per Year: |
$750 per person |
$1,000 per person |
$1,000 per person |
Orthodondic Lifetime
Benefit (available to age 19): |
N/A |
N/A |
$1,000 per person |
Monthly
Rates: |
|||
Single: |
$29.60 |
$40.41 |
$40.47 |
Two Person: |
$59.21 |
$80.83 |
$82.26 |
Family: |
$107.82 |
$126.78 |
$133.29 |
Please Download the following Adobe Acrobat PDF Files for forms
and information:
• Enrollment Checklist
• Premium Calculation Form
• Employer Agreement
• Electronic Bank Draft Form
• Non-Participation Waiver Form
• Enrollment Form
• Summary Plan Description Plan A
• Summary Plan Description Plan B
• Summary Plan Description Plan C
Click
Here to download
Adobe Acrobat Reader.
