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Dental Plan

It’s important to have regular dental exams and cleanings so problems are detected before they become painful — and expensive.
Keeping your teeth and gums clean and healthy will help prevent most tooth decay and is an important part of maintaining your
overall health.
Leona offers Regular Full-Time employees dental coverage administered by Delta Dental of Arizona. The chart below shows the
percentage you pay for certain dental services.

Choosing Dental Providers
Plan Provisions Delta Dental
The dental plan includes two networks of providers (Premier
Annual Deductible $50/$150 and PPO) but also allows you to receive treatment from a
(Individual/Family)
provider of your choice. However, if you use a network
Calendar Year Maximum $1,500 per individual provider, you will generally pay less in out-of-pocket costs.
Save even more money by using a Delta Dental PPO (versus
Orthodontia Lifetime Maximum $1,500 per individual Premier) provider. Services can be considerably less expensive
at PPO providers due to Delta Dental’s contract arrangements
Diagnostic and Preventive Services
Covered at 100% with these providers.
(e.g., X-rays, cleanings, exams)
If you use an out-of-network provider, you will be responsible
Basic and Restorative Services
20%* for paying the difference between your dentist’s billed
(e.g., fillings)
charges and Delta’s allowable fee, in addition to your normal
Major Services percentage of the cost. The dentist may also require that you
(e.g., dentures, crowns, bridges) 50%* pay for services in advance and submit your own claim to
Delta Dental.
Orthodontia 50%
*After deductible

Note: If you or your dependents need extensive dental Register to access Consumer Toolkit at Delta Dental of
treatments, you should ask your dentist to submit a Arizona where you can view claims, print Id cards,
pre-determination of benefits to Delta Dental. By doing so,
and find participating providers at
both you and the dentist will know in advance how much your
www.deltadentalaz.com.
dental plan will pay for the course of treatment.

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