Preventive care is 100% covered*

• This includes cleaning, fluoride, bitewing X-rays, exams, sealants, and more when you see a Delta Dental PPO dentist—with no deductible required.
• You can also see any Delta Dental Premier dentist for the same preventive care services, and the plan pays 80%.

For the rest, you’ll pay for care out of pocket until you reach your deductible: $75 for individuals or $225 for families. After that, here’s what the plan picks up:

• 80% for basic care, including most fillings, non-surgical periodontics, root canal therapy, and extractions.
• 50% for major care, like surgical periodontics, crowns, dentures, implants, and oral surgery.

*Limits may apply.

• Choose any Delta Dental PPO dentist, or in some areas, a Delta Dental Premier dentist (see below).
• Show your plan ID card when you go in.
• Pay any required charges during your visit. Your dentist and the plan will take care of the rest.
• If for some reason your benefit isn’t handled automatically, you can file a claim through the plan’s website.

Most associates are only covered if they see Delta Dental PPO dentists, except for preventive care. In certain areas where not enough PPO dentists are available, you can also see any dentist in the wider Delta Dental Premier network and get the same coverage. To see if you’re included, call People Services at 1-800-421-1362.

• Your annual deductible is $75 per person with a maximum of $225 per family. This is the amount you’ll need to spend before the plan picks up coverage for basic and major care.
• The plan’s annual maximum benefit is $2,500 per covered person.
• Once you sign up, you’ll need to stay enrolled for two calendar years.

• You need to be enrolled for a full year before you’re eligible for orthodontia coverage.
• This benefit is limited to a $1,500 lifetime maximum per covered person.
• No deductible is required, and charges don’t apply to your deductible.