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Benefits • Dental

Your Plan is Administered by Delta Dental of Kansas

Two levels of coverage are offered:

The Basic Plan provides benefits for diagnostic, preventive and basic care eligible charges (include exams, cleanings, fillings and X-rays).

The Comprehensive Plan offers coverage for a more extensive range of dental care including orthodontia.

Delta Dental Network

Your dental plan includes two networks:

Premier Network
Includes more than 118,000 dentists nationwide.

Going to a Premier dentist means:
- No balance billing
- No paper claim filing

PPO Network
Includes more than 57,000 dentists nationwide.

Going to a PPO Delta Dental provider means:
   - Largest discounts
   - No balance billing
   - No paper claim filing

Resources

Benefit Handbooks

2009 Benefits Guide

Benefit Vendor Directory

Terms to Know

Eligibility Information

Price Sheets FT / PT

Contact Information:
www.deltadentalks.com
1-800-234-3375

	Basic Plan	Comprehensive Plan
Deductible (per covered person)	$150 (per family)	$300 (per family)
Preventive/Diagnostic (2 cleanings per yr)	100% (not subject to deductible)	100% (not subject to deductible)
Basic Services	80% after deductible	80% after deductible
Major Services	Not covered	50% after deductible
Annual Benefit Maximum	$750 (per person)	$1,500 (per person)
Orthodontia	Not covered	50% after deductible (children and adults)
Lifetime maximum	(N/A)	$2,000 (per person)

Going to an in-network provider saves you money.
Example of in-network savings

	PPO Network	Premier Network	Non-Network
Dentist Bills	$1,000	$1,000	$1,000
Delta's Max Allowance	$650	$700	$650
Delta Payment	$325	$350	$325
Balance Bill	$0	$0	$350
Your Payment	$325	$350	$675

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