Options Blue Dental Benefits and Rates

Options Blue - Dental Benefits and Rates - (Effective April 1, 2010)

Benefits
Your coverage *	Plan A $100 annual deductible with $1,250 annual coverage maximum	Plan B $250 annual deductible with $1,000 annual coverage maximum
Services covered immediately
Diagnostic/preventive Routine exams and cleanings, including periodontal cleaning	100% No deductible for routine check-ups.	80%
Prosthodontic (denture) repairs and adjustments	80%	50%
Basic restorative Fillings and sealants	80%	50%
Oral surgery Including extractions	50%	50%
Endodontics Root canals	50%	50%
Services covered after a 12-month period
Periodontal care Treatment of gum disease	50%	50%
Crown and cast restorations	50%	50%
Prosthodontics Dentures, partial dentures, and bridges	50%	50%
Orthodontics (optional) Available for dependent children only, age 8-18	50% $1,000 lifetime maximum	50% $1,000 lifetime maximum
* Coverage at non-network dentists is subject to the maximum amount payable (MAP), which is the maximum amount Delta Dental will pay for a given procedure. If you receive care from a non-network dentist who charges more than the MAP, you’ll be responsible for the additional amount. Delta Dental network dentists agree not to charge more than the MAP.