Dental
Forvis Mazars offers two dental plans to choose from to fit your needs. These plans are provided by Delta Dental of MO and offer nationwide coverage of in-network providers providing discounted rates through their Preferred Provider Organization (PPO) network. If your dentist is not within the Delta Dental network, you have the same benefits listed in your summary guide through the Delta Dental Premier Network, just without the additional savings of an in-network provider. You will be responsible for the difference in what your out-of-network provider bills and what Delta Dental pays.
|
Standard Plan (In-Network Benefits) |
Premier Plan (In-Network Benefits) |
|
|---|---|---|
| Calendar year maximum | $1,000 | $2,000 |
| Calendar year deductible | $50/Individual | $50/Individual |
| Preventative Services | You pay 0% | You pay 0% |
| Basic Services | You pay 20% after the deductible |
You pay 20% after the deductible - includes Endodontics and Periodontics |
| Major Services (includes Crowns) |
You pay 50% after the deductible - includes Endodontics and Periodontics |
You pay 50% after the deductible |
| Orthodontia | No Orthodontia coverage, regardless of age | Delta Dental pays a maximum of 50%, up to a $2,000 lifetime maximum for both children and adults |
| Monthly Premium - Employee Portion | $18.00 | $29.00 |
|
Standard Plan (In-Network Benefits) |
Premier Plan (In-Network Benefits) |
|
|---|---|---|
| Calendar year maximum | $1,000 | $2,000 |
| Calendar year deductible |
$50/Individual $150/Family |
$50/Individual $150/Family |
| Preventative Services | You pay 0% | You pay 0% |
| Basic Services | You pay 20% after the deductible |
You pay 20% after the deductible - includes Endodontics and Periodontics |
| Major Services (includes Crowns) |
You pay 50% after the deductible - includes Endodontics and Periodontics |
You pay 50% after the deductible |
| Orthodontia | No Orthodontia coverage, regardless of age | Delta Dental pays a maximum of 50%, up to a $2,000 lifetime maximum for both children and adults |
| Monthly Premium - Employee Portion | $34.00 | $58.00 |
|
Standard Plan (In-Network Benefits) |
Premier Plan (In-Network Benefits) |
|
|---|---|---|
| Calendar year maximum | $1,000 | $2,000 |
| Calendar year deductible |
$50/Individual $150/Family |
$50/Individual $150/Family |
| Preventative Services | You pay 0% | You pay 0% |
| Basic Services | You pay 20% after the deductible |
You pay 20% after the deductible - includes Endodontics and Periodontics |
| Major Services (includes Crowns) |
You pay 50% after the deductible - includes Endodontics and Periodontics |
You pay 50% after the deductible |
| Orthodontia | No Orthodontia coverage, regardless of age | Delta Dental pays a maximum of 50%, up to a $2,000 lifetime maximum for both children and adults |
| Monthly Premium - Employee Portion | $32.00 | $79.00 |
|
Standard Plan (In-Network Benefits) |
Premier Plan (In-Network Benefits) |
|
|---|---|---|
| Calendar year maximum | $1,000 | $2,000 |
| Calendar year deductible |
$50/Individual $150/Family |
$50/Individual $150/Family |
| Preventative Services | You pay 0% | You pay 0% |
| Basic Services | You pay 20% after the deductible |
You pay 20% after the deductible - includes Endodontics and Periodontics |
| Major Services (includes Crowns) |
You pay 50% after the deductible - includes Endodontics and Periodontics |
You pay 50% after the deductible |
| Orthodontia | No Orthodontia coverage, regardless of age | Delta Dental pays a maximum of 50%, up to a $2,000 lifetime maximum for both children and adults |
| Monthly Premium - Employee Portion | $52.00 | $115.00 |
| Employee Portion | Firm's Portion | Monthly Premium | |
|---|---|---|---|
| Employee Only | $18 | $16 | $34 |
| Employee & Spouse | $34 | $33 | $67 |
| Employee & Child(ren) | $32 | $32 | $64 |
| Employee & Family | $52 | $52 | $104 |
| In-Network Benefits | |
|---|---|
| Calendar year maximum | $1,000 |
| Calendar year deductible |
$50/Individual $150/Family |
| Preventative Services | You pay 0% |
| Basic Services | You pay 20% after the deductible |
| Major Services (includes Crowns) |
You pay 50% after the deductible - includes Endodontics and Periodontics |
| Orthodontia | No Orthodontia coverage, regardless of age |
| Employee Portion | Firm's Portion | Monthly Premium | |
|---|---|---|---|
| Employee Only | $29 | $19 | $48 |
| Employee & Spouse | $58 | $39 | $97 |
| Employee & Child(ren) | $79 | $51 | $130 |
| Employee & Family | $115 | $76 | $191 |
| In-Network Benefits | |
|---|---|
| Calendar year maximum | $2,000 |
| Calendar year deductible |
$50/Individual $150/Family |
| Preventative Services | You pay 0% |
| Basic Services |
You pay 20% after the deductible - includes Endodontics and Periodontics |
| Major Services (includes Crowns) | You pay 50% after the deductible |
| Orthodontia | Delta Dental pays a maximum of 50%, up to a $2,000 lifetime maximum for both children and adults |
Additional Information
- You can elect the Delta Dental of MO dental plan regardless of whether you are enrolled in the medical or vision plan.
- The maximum dependent age is 26 (regardless of student status).
- You may order or print an ID card for dental by registering with Delta Dental of MO. Please review the information in the Member Portal Instructions document under Key Resources.
Key Resources
General Information
Standard Dental
Premier Dental
Notice: Please note that during the calendar year, our plans do not allow you to switch from one plan to another (e.g. Standard to Premier or vice versa). With a qualifying event, you may add or remove dependents, but you must remain within the same plan for the remainder of that calendar year. You may change your plan during open enrollment each year to be effective the next calendar year.