Page 12 - Arrowhead Credit Union Benefit Guide 2019 - Final

Dental Health Services | DHMO Dental Plan
With the Dental Health Maintenance Organization (DHMO) plan through Dental Health Services, 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 schedule of covered services and copayments. Please keep a copy
of your schedule 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.

Dental Health Services | PPO Dental Plan
With the Dental Health Services Preferred Provider Organization (PPO) dental plan, 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.

Dental Health Services Dental Health Services
Plan Name DHMO Plan PPO Plan
Network Name Arrowhead Credit Union Network Network Non-Network

Dental Benefits
Calendar Year Maximum Unlimited $1,500 per member $1,500 per member

Deductible (Annual)
- Individual $0 $50 $50
- Family $0 $150 $150

Preventive See Schedule of Benefits No Charge No Charge
Exams, X-Rays, Cleanings

Basic Services See Schedule of Benefits Deductible, 10% Deductible, 20%
Fillings, Oral Surgery

Major Services See Schedule of Benefits Deductible, 40% Deductible, 50%
Crowns, Prosthetics
Orthodontia
- Covered Members Children & Adults DHMO Not Covered
- Copay $1,775 Child / $1,975 Adult Ortho Benefit

Finding a Dental Provider
Go to www.dentalhealthservices.com or call (800) 637-6453. DHMO participants should refer to
the Arrowhead Credit Union network and PPO participants should refer to the “First Dental Health”
network when prompted.

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