Page 9 - Veritone's EE Guide final

Benefits

Dental Insurance

Anthem Blue Cross | PPO Dental Plans
With the Anthem Blue Cross Dental Essential Choice Preferred Provider Organization (PPO) plans, you may visit a PPO dentist and
benefit from the negotiated rate or visit a non‐network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be
less. You may also obtain services using a non-network dentist; 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 Blue Cross Anthem Blue Cross
Plan Name PPO High Plan PPO Low Plan
Network Name Anthem Dental Non-Network Anthem Dental Non-Network
Complete Complete
Dental Benefits

Calendar Year Maximum $1,500 $1,500 $1,000 $1,000
- Per Insured Person
Deductible (Annual)
- Individual $50 $100 $100 $150
- Family $150 $300 $300 $450
Preventive (Plan Pays) 100% 100% 100% 100%
Exams, X-Rays, Cleanings

Basic Services (Plan Pays) Deductible, 90% Deductible, 80% Deductible, 70% Deductible, 50%
Fillings, Oral Surgery,
Endodontics, Periodontics
Major Services (Plan Pays) Deductible, 65% Deductible, 50% Deductible, 50% Deductible, 50%
Crowns, Prosthetics, Teeth Whitening

Orthodontia

- Covered Members Not Covered
Children & Adults
- Deductible None N/A
- Coinsurance 50% N/A
- Lifetime Benefit Maximum N/a
$1,500
- Per Insured Person

Finding a Dental Provider
Go to www.anthem.com/ca or you may call (877)567-1804
Refer to the Anthem Dental Complete network when prompted

Note
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.

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