Dental

Foth has two plans to choose from, and pays a portion of the total premium.

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1. Deluxe Summary of Dental Benefits
Foth Deluxe Dental Summary Plan Description – Effective 1.1.2020

2. Basic Summary of Dental Benefits
Foth Basic Dental Summary Plan Description – Effective 1.1.2020

Covered preventive and diagnostic services are paid at 100% on either plan. Claims paid for such services do not reduce the annual maximum benefit. Additional preventive periodontal cleanings are available to those who have specific medical conditions (i.e., pregnancy, cancer, diabetes, high risk cardiac, and periodontal diseases). To receive these additional cleanings, enroll through the Delta Dental website.

Note: You should never be charged an additional fee for any Personal Protective Equipment (PPE) or infection control procedures when receiving care from a Delta Dental network provider, as this is considered part of the fee for complete service.  If you experience issues with charges for PPE, contact Delta Dental.

Access your Delta Dental Account

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  • Locate In-Network Providers: Searching for a dentist?  Consider a PPO dentist! PPO dentists have agreed to a lower contracted rate, thus saving you money.  If your current dentist is not a PPO dentist, encourage them to consider making the switch.  Choosing a dentist.
  • View Claims:  Access information about claims. Understanding your Explanation of Benefits (EOB)
  • ID Cards:  Print and/or request your ID card (If unable to log in, email Enrollment@deltadentalwi.com)
  • Access the Dental Claim Reimbursement Form: Used for dental expenses not applied towards the plan at the time of service
  • Assess your Risk of Dental Disease: Complete a wellness survey.
  • Enroll in Evidence-Based Integrated Care Plan (EBICP):  Allows up to 4 cleanings covered as preventive for certain conditions. Access additional information.

Dental Premiums (Per Paycheck)

  Deluxe  Basic
  Single  $11.56  $6.19
  Member +1  $27.79  $15.38
  Family  $33.00  $16.28

 


Forms

Affidavit-of-Domestic-Partnership – To qualify a domestic partner for coverage under Foth’s health insurance


Questions?

Delta Dental
Eligibility, claim issues, provider search
800-236-3713 or www.deltadentalwi.com

Benefits/Human Resources
For questions about enrollment, plan changes or general benefits inquiries, email Benefits@foth.com