Double-Up Max℠ Carryover Benefit Earn Additional Benefit Dollars INCREASE YOUR ANNUAL BENEFIT MAXIMUM Northeast Delta Dental offers a Double-Up Max carryover benefit feature on select dental programs. The Double-Up Max feature allows you to carry over a portion of your unused annual maximums from one benefit period to the next. This benefit offers more flexibility and helps you plan for more extensive and costly dental treatments in subsequent years. HOW IT WORKS The following chart is an example of how it works: (Please note: This is only an example. Your Annual Maximum may be different than the example shown.) Year 1 Year 2 Year 3 Calendar Year Maximum $1,500 Calendar Year Maximum $1,500 Calendar Year Maximum $1,500
Double-Up Max benefit from previous years (year 1)
Accumulated Double-Up Max from previous years (year 1)
Double-Up Max benefit from previous years
N/A
$250
$250
Benefit Dollars Available
$1,500
Benefit Dollars Available
$1,750
Benefit Dollars Available
$1,750
$300 (less than $500)
$750 (over $500)
$425 (less than $500)
Total claims paid
Total claims paid
Total claims paid
Oral Exam or Cleaning during year
Oral Exam or Cleaning during year
Oral Exam or Cleaning during year
YES
YES
YES
NO (over $500 threshold)
Qualified for Double-Up Max
Qualified for Double-Up Max
Qualified for Double-Up Max
YES
YES
Earned Double-Up Max available for use in subsequent years
Earned Double-Up Max available for use in subsequent years
Earned Double-Up Max available for use in subsequent years*
$250
$0
$250
*Accumulated Double-Up Max available in Year 4 = $500
Guidelines • Your dental plan must have a calendar year annual maximum. • Northeast Delta Dental must have paid a claim for either an oral exam or cleaning during the calendar year. • An enrollee’s paid claims during the Calendar Year cannot exceed a $500 threshold. • Carryover benefit amounts cannot be used toward the orthodontic lifetime max. • The total accumulated carryover amount cannot exceed the amount of your plan’s annual maximum.
Northeast Delta Dental • 1-800-537-1715 • nedelta.com
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Rev. 09/28/21
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