Page 9 - Veritax EE Guide 10-1-2019 - CA

BENEFITS

DENTAL INSURANCE

Anthem | DHMO Dental Plan
With the Dental Health Maintenance Organization (DHMO) plan through Anthem, you are required to select a general dentist to
provide your dental care. You will contact your general dentist for all of your dental needs, such as routine check‐ups and
emergency situations. If specialty care is needed, your general dentist will provide the necessary referral. For covered procedures,
you'll pay the pre‐set copay or coinsurance fee described in your DHMO plan booklet. Please keep a copy of your booklet to refer
to when utilizing your dental care. This will show the applicable copays that apply to all of the dental services that are covered
under this plan.

Anthem | PPO Dental Plan
With the Anthem Preferred Provider Organization (PPO) dental plan, you may visit a Choice dentist, a PPO dentist, or a non-
network dentist. When you utilize a Choice or PPO dentist, your out-of-pocket expenses will be less, however, you will usually pay
the lowest amount for services when you visit a Choice 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.

Anthem Anthem
DHMO Plan PPO Plan

Network Name Dental Net HMO Dental Complete Non-Network
Dental Benefits

Office Visit Copay $0 Copay N/A
Calendar Year Maximum Unlimited $2,000
Deductible (Annual)
- Individual $0 $50
- Family $0 $150

Preventive (Plan Pays) 100% for Most Services 100% 100%
Exams, X-Rays, Cleanings (80th UCR)

Basic Services (Plan Pays) See Copay Schedule Deductible, 90% Deductible, 90%
Fillings, Oral Surgery, (80th UCR)
Endodontics, Periodontics
Major Services (Plan Pays) See Copay Schedule Deductible, 60% Deductible, 60%
Crowns, Prosthetics (80th UCR)

Orthodontia
- Covered Members Children & Adults Children & Adults
- Copay $1,695 Child / $1,895 Adult N/A
- Coinsurance N/A 50%
- Lifetime Benefit Maximum N/A $2,000

Finding a Dental Provider
Go to www.anthem.com/ca, scroll down to the Find a Doctor link. Under the Search as a Guest options,
select Search by Selecting a Plan or Network. Select Dental, then your state, then the appropriate plan
network:
• DHMO: Dental Net HMO
• PPO: Dental Complete
For further assistance, call Anthem’s member service at (855) 383-7248

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