9/17/2020

1

Welcome to your

Dental Benefits Program 2 Options: PPO (High & Low plans)

Pre-treatment estimate It’s easy to plan for dental expenses

1ST

2ND

3RD

Ask your dentist to request the Pre-treatment estimate

Dentist sends details to Delta Dental

You and your dentist receive a cost estimate

1

2

9/17/2020

2

BenefitsandCoveredServices

Dental PPO Plan Highlights

Benefits illustrated above are not intended for use as a comprehensive description of the Plan. Please consult your benefit booklet for complete details, including limitations and exclusions.

Low Plan High Plan

In-network (PPO in/out)

Out-of-network

In-network (PPO/PRE)

Out-of-network

WHO’S ELIGIBLEPrimary enrollee, spouse and eligible dependent childrento age 26

DEDUCTIBLES $ 50 per person, $150 per family, per plan year

DEDUCTIBLE WAIVED FOR D&P?D&P COUNT TOWARD ANNUAL MAXIMUM?

YesYes

ANNUAL MAXIMUM $750 $1,750 $1,500

DIAGNOSTIC & PREVENTIVE BENEFITS -- Oralexaminations, cleanings, x-rays, fluoride treatment, space maintainers, sealants

100% 100% 100% 100%

BASIC BENEFITS --Fillings, denture repairs, Endodontics (root canals), Periodontics (gum treatment) , Oral Surgery

60% 60% 80% 65%

MAJOR BENEFITS -- Crowns, jackets and cast restorations and prosthodontics (bridges, partial dentures, full dentures, implants)

0% 0% 50% 40%

ORTHODONTICS (Adults & Dependent Children) 0% 0% 50% 50%

ORTHODONTIC LIFETIME MAXIMUMORTHODONTIC ANNUAL MAXIMUM (Paid Quarterly)

DEDUCTIBLE (Lifetime)

N/A N/A $2,000

$1,000

$50

$2,000

$1,000

$50

Low & High plan differences

What are the main differences in plans?

1ST

2ND

3RD

Annual Max - $750 vs $1,750 ($1,500 on High plan if seeing OON provider)

Orthodontia - covered on High plan for adults and children. No coverage on Low plan

12 mo. Waiting Period (WP) on High plan for Major & Ortho Services. Months on Low plan count toward High plan WP

4th Low plan is PPO in/out. All claims are paid at the PPO level

5th High plan - Better benefits if going to a PPO or Premier provider

3

4

9/17/2020

3

* This is for illustrative purposes only. Assume no maximum or deductibles apply. Payment is based on PPO fees for PPO dentists,PPO fees for Premier dentists and PPO fees for non–Delta Dental dentists.

Maximize your savings (Low plan) Visit a PPO dentist

Delta Dental PPOSM

dentistDelta Dental

Premier® dentistNon–Delta

Dental dentistDentist charges $90 $90 $90Dentist accepts as full payment

$45 $55No fee agreement with Delta Dental

You’re plan pays $45 $45 $45You pay $45-$45=

$0$55-$45=

$10$95-$45=

$45

You pay nothing for a cleaning with PPO*

This is for illustrative purposes only. Assume no maximum or deductibles apply. PPO dentists are paid up to the PPO fee, Premierdentists are paid up to the Premier fee and non–Delta Dental dentists are paid up to the maximum plan allowance.

Maximize your savings (High plan) Visit a Delta Dental dentist

Delta Dental PPOSM

dentistDelta Dental

Premier® dentistNon–Delta

Dental dentistDentist charges $1,198 $1,198 $1,198Dentist accepts as full payment

$628 $770No fee agreement with Delta Dental

You’re plan pays $314 $385 $385You pay $628-$314=

$314$770-$385=

$385$1,198-$385=

$813

You pay less for a crown with PPO*

Covered at 50% at PPO and Premier dentists, 40% at non–Delta Dental dentists

5

6

9/17/2020

4

THANK YOU FOR YOUR TIME.We’re pleased to take your questions…

7