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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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