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DENTAL INSURANCE

ANTHEM | PPO DENTAL PLAN
Available in all states
With the Anthem PPO Dental plan, you may visit a PPO den st and benefit from the nego ated rate or visit a non‐network
den st. When you u lize a PPO den st, your out‐of‐pocket expenses will be less. You may also obtain services using a non‐
network den st; however, you will be responsible for the difference between the covered amount and the actual charges and
you may be responsible for filing claims.

Anthem
Plan Features PPO
Network PPO Network Non‐Network*

DENTAL BENEFITS Dental Complete
Calendar Year Maximum Benefit $2,000

Annual Deduc ble
Individual $50 $50
Family 3x Individual 3x Individual
Waived for Preventa ve Services Yes Yes
Preven ve Services (Plan Pays) 100% 100%
Oral Exams, Cleanings, Rou ne X‐Rays, Fluoride Applica on, Deduc ble waived Deduc ble waived
Sealants, Full‐mouth X‐Rays
Basic Services (Plan Pays) 100% 80%
Fillings, Space Maintainers (non‐orthodon c), Oral Surgery ‐
Simple & Uncomplicated Extrac ons, Surgical & Non‐Surgical
Periodon cs, Root Canal Therapy / Endodon cs, Brush Biopsy

Major Services (Plan Pays) 60% 50%
Crowns, Inlays, Onlays, Dentures, Implants, Bridges, Relines,
Rebases, and Adjustments, Repairs ‐ Bridges, Crowns, and
Inlays

Orthodon a
Covered Family Members Adult & Children
Coinsurance 50%
Life me Benefit Maximum $1,500

*If you reside in TX, non‐network benefits will mirror PPO Network benefits.

PLEASE NOTE
We strongly recommend you ask your den st for a predetermina on if total charges are expected to exceed $300.
Predetermina on enables you and your den st to know in advance what the payment will be for any service that may be
in ques on.

FINDING A DENTAL PROVIDER:
Go to www.Anthem.com. Select “Dental Complete” or call 800.627.0004

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