Page 10 - Cylance EE Guide 01-19 All Employees

BENEFITS

Dental Insurance

Delta Dental | PPO Dental Plan
With the Delta Dental Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist, a Premier dentist, or a non-
network dentist. When you utilize a PPO or Premier dentist, your out-of-pocket expenses will be less, however, you will usually pay
the lowest amount for services when you visit a PPO dentist. If you obtain services using a non-network dentist, you will incur much
higher out-of-pocket expenses and you may be responsible for filing claims.

Delta Dental
Plan Name PPO Plan
Network Name PPO Premier Non-Network
Dental Benefits

Calendar Year Maximum $1,500 $1,500 $1,500
Deductible (Annual)
- Individual $50 $50 $50
- Family $150 $150 $150

Preventive No Charge No Charge No Charge
Exams, X-Rays, Cleanings
Basic Services Deductible, 10% Deductible, 20% Deductible, 20%
Fillings, Oral Surgery, Endodontics, Periodontics
Major Services Deductible, 40% Deductible, 50% Deductible, 50%
Crowns, Prosthetics
Orthodontia
- Covered Members Adult and Children
- Coinsurance 50%
- Lifetime Benefit Maximum $1,500

Finding a Dental Provider
Go to www.deltadentalins.com or call (800) 765-6003. Refer to the “PPO” or “Premier” network.

Tips For Using Your Dental Benefits


Use contracted network providers when possible.
Under the PPO plan, contracted network providers have rate agreements with insurance companies for services rendered. If
you use a non-network provider, your out-of-pocket expenses will be higher and you may be subject to balance billing.

Ask for a predetermination of benefits.

We strongly recommend you ask your dentist for a predetermination if total charges are expected to exceed $300.
Predetermination enables you and your dentist to know in advance what the payment will be for any service that may be in
question.


Have dental checkups regularly.
Routine dental visits not only preserve your smile, but they can provide an opportunity for the early detection of serious
diseases such as diabetes.

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