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

BENEFITS

DENTAL INSURANCE

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
PPO Plan

Network Name Dental Complete Non-Network
Dental Benefits
Office Visit Copay N/A

Calendar Year Maximum $2,000
Deductible (Annual)
- Individual $50
- Family $150

Preventive (Plan Pays) 100% 100%
Exams, X-Rays, Cleanings (80th UCR)
Basic Services (Plan Pays) Deductible, 90% Deductible, 90%
Fillings, Oral Surgery, (80th UCR)
Endodontics, Periodontics

Major Services (Plan Pays) Deductible, 60% Deductible, 60%
Crowns, Prosthetics (80th UCR)

Orthodontia
- Covered Members Children & Adults
- Copay N/A
- Coinsurance 50%
- Lifetime Benefit Maximum $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:
• PPO: Dental Complete
For further assistance, call Anthem’s member service at (855) 383-7248

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