Page 8 - CPC Behavioral Healthcare 2022 - 2023 Benefits Guide

DENTAL PLANS

YOUR DENTAL COVERAGE

Regular dental exams can help you and your dentist

detect problems in the early stages when treatment is

more basic and costs are much lower. Keeping your teeth
and gums clean and healthy will help prevent most tooth
decay and periodontal disease, and is an important part

of maintaining your medical health.

CPC offers you a choice of three dental plans through
Delta Dental: the $1,750 Maximum Premier PPO, the

$1,000 Maximum Premier PPO, and the Flagship DHMO.

To locate a dentist, visit www.deltadentalnj.com or call 1-800-452-9310.
A summary of what you pay is below.

COVERAGE $1,750 Benefit Maximum $1,000 Benefit Maximum No Benefit Maximum
PROVISION Premier PPO Premier PPO Flagship DMO
Primary Dentist Required

Annual deductible
Individual/Family $50/$150 $50/$150 None

Annual maximum per person (the $1,750 $1,000 None
most the plan will pay )
Diagnostic and Preventive, to

include cleanings, fluoride 0% no deductible 0% no deductible
treatments, sealants and x-rays
Basic Services to include fillings,
periodontics, scaling and root 20% after deductible 20% after deductible Fixed copayment based
planning, oral surgery upon service*
Major Services to include crowns,
50% after deductible 50% after deductible
bridges, full and partial dentures

Orthodontia (Child only up to age 19) 50%; $1,000 lifetime maximum 50%; $1,000 lifetime maximum

payment payment

*Find the Flagship DHMO fee schedule can be found on e-3

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