Sentry 2019 Dental Benefits Guide
Your Dental Benefits
Delta Dental Premier
Non-Contracted Dentist
Benefit Plan Design
Delta Dental PPO
Individual Annual Maximum
$1,750
Deductible – Individual / Family
$50 / $150
Diagnostic and Preventive Services (deductible does not apply) Two exams, two cleanings, fluoride treatments, X-rays, sealants, space maintainers Basic Services (deductible applies) Emergency treatments, fillings, endodontics, periodontics, extractions Major Restorative Services (deductible applies) Crowns, inlays, onlays, bridges, dentures, implants, repairs to bridges and dentures
X
X 100%
80%
X 50%
Orthodontic Services (deductible does not apply)
50% Up to $1,750 (Children and Adult)
X Discounted fees. Saves money, not as much as PPO.
Discounted fees. Saves you the most money.
No discounted fees. No savings.
Network Information
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