DENTAL

Delta Dental is GEON’s dental insurance provider. If you have any questions regarding the dental plan or want to find a network provider, visit Delta Dental at deltadentaloh.com or call 1-800-524-0149.

Things to Consider About the Dental Plan

When you need dental care, you can go to any provider you choose. However, using network providers can save you money in two ways:

Participating network providers agree to accept Delta Dental’s fee based on their agreement with Delta Dental, which is typically lower than a provider that does not participate in a Delta Dental Network
You do not have to pay any amount above Delta Dental’s allowed fee when you receive care from a provider that participates in one of Delta Dental’s networks (PPO Network or Premier Network)

Resources

Delta Dental Summary of Benefits

Delta Dental Q&A

Delta Dental App

	PPO	Premier	Out-Of-Network
Preventive Services: Includes two exams per year. May also include cleanings (2 per year), X-Rays (bitewings 1 per year), sealants, fluoride treatments up to age 14 and space maintainers	100%	90%	80%
Basic Services: Includes amalgam and resin filling, root canal, oral surgery, repairs of crowns, bridgework and dentures, and periodontal services affecting gums and other tissues surrounding teeth	80%	70%	60%
Major Services: Includes crowns, bridges, dentures and implants	50%	45%	40%
Orthodontic Services: Children age 19 and under only	50%
Maximum lifetime limit	$1,500
Annual Deductible*	$50 per person $150 per family
Annual Maximum Benefit (Excludes Preventive Services)	$1,350 per person

*$50 per person to a maximum of $150 per family

Rates

Per Pay Pre-Tax Contribution Levels	Rate
Employee Only	$6.53
Employee + Spouse	$13.05
Employee + Child(ren)	$16.74
Family	$25.65

* Rates shown include the Tobacco Free incentive