Dental Plans

Cost Comparison

The following chart provides a comparison of out-of-pocket costs for certain types of procedures. Consult each plan's "Evidence of Coverage" brochure for detailed information and plan limitations.

	Delta Dental				SafeGuard, PMI	SafeGuard
	DeltaPremier Basic		DeltaPremier Enhanced	**DeltaPreferred Option (DPO)	Standard	Enhanced***
Procedure	Rank-and-File Employees	Dependents of Rank-and-File Employees	Excluded Employees and Dependents	Excluded & Rank-and-File Employees and Dependents	Excluded & Rank-and-File Employees and Dependents	Excluded Employees and Dependents
Diagnostic and Preventive Benefits (Two cleanings per 12-month period) *	0	0	0	0	0	0
Basic Benefits (Usual, Customary, and Reasonable)	10%	20%	10%	10%	0	0
Crowns	20%	50%	20%	20%	$50	0
Bridges, Full and Partial Dentures	50%	50%	50%	40%	$65 and up	0
Annual Deductible	$50*	$50*	$25*	$25*	No deductible	No deductible
Maximum Deductible	$150 per family		$100 per family	$100 per family	N/A	N/A
Orthodontia	Delta will pay 50% up to a lifetime maximum of $1,000 per person.			Delta will pay 50% up to a lifetime maximum of $1,000 per adult, and 50% up to a lifetime maximum of $1,500 per child.	$1,000 plus up to $250 for start-up costs	$1,000 plus up to $250 for start-up costs
Annual Maximum	$2,000	$1,000	$2,000	$2,000	No Maximum	No Maximum

* Diagnostic and Preventive Benefits are exempt from the deductible.

** Based on services provided by a DPO network dentist. Level of benefits and covered services provided by a non-DPO dentist are lower. Additionally, the DPO includes up to a $2,500 lifetime benefit for dental implants and a third cleaning for high-risk patients (pregnant women, cancer chemotherapy patients, persons with compromising systemic diseases such as AIDS, diabetes, endocarditis, and persons who have had organ transplants).

*** Provides for three cleanings per 12-month calendar year instead of normal two cleanings.