Dental Plan Effective January 1, 2016
You may receive services from any licensed dental provider. However, your choice of dentist determines the benefits you will receive and your out-of-pocket expenses. The amount paid by the Carpenters' Plan is higher when you select a dentist who participates in the Delta Dental PPO™ Network. For instance, if you use a:
- Delta Dental PPO™ Network dentist, you will receive the highest benefits, greatest discounts, lowest annual deductible and will have the least out-of-pocket expense. In addition, there is no deductible for preventive services when you select a Delta Dental PPO™ provider.
- Delta Dental Premier® Network dentist, there is a $50 deductible before preventive benefits are available, the total annual deductible is higher and the benefits you will receive will be less than if you use a Delta Dental PPO™ provider. This will result in more out-of-pocket expense for you.
- Dentist who is not in a Delta Dental Network there is a $75 deductible before preventive benefits are available, the benefits you will receive will be less than if you use a Delta Dental PPO™ provider, there are no discounts and you will have the highest out-of-pocket expense.
| Dental Plan Coverage Effective January 1, 2016 |
|---|
| Dental Benefit Coverage Category | Network | Out of Network |
|---|
| Delta Dental PPO™ | Delta Dental Premier® |
|---|
|
Deductible (Preventive)
|
$0.00
|
$50.00
|
$75.00
|
|
Preventive Services
|
100%
|
75%
|
50%
|
|
Deductible (All other Benefits)1
|
$50.00
|
$75.00
|
$75.00
|
|
Basic Services
|
80%
|
50%
|
25%
|
|
Major Services
|
50%
|
40%
|
25%
|
|
Annual Maximum2
|
$1,500.00 with/ MAXAdvantage
|
|
Orthodontic Services
|
50%
|
|
Ortho Lifetime Maximum
|
$1,500.00
|
|
Special Provisions
|
|
MAXAdvantage3
|
Included
|
|
Healthy Smiles / Healthy Lives4
|
Extra cleanings for designated health conditions
|
|
1Deductible is cumulative – if the $50 deductible is met for preventive service from a Delta Dental Premier® dentist, the patient only has an additional $25 to reach the $75 deductible. If the first services received are basic/major, the deductible is $75.
|
|
2Annual maximum does not apply to children ages 0-19 for preventive dental services.
|
|
3MAXAdvantage does not apply routine exams and cleanings to the out of pocket maximum for these services twice per year.
|
|
4Healthy Smiles / Healthy Lives allows for increased cleanings for individuals with certain diagnoses.
|
|
Examples of Dental Procedures
|
|
Preventative Services: Routine exam, cleaning, routine x-rays
|
|
Basic Services: Extractions, amalgam fillings, root canal therapy
|
|
Major Services: Crowns, fixed bridgework and dentures
|
During 2019, over 68% of the Carpenters' members and their families who received dental care used a dentist in the Delta Dental PPO™ Network. By using a Delta Dental PPO™ provider, this helps reduce their out-of-pocket dental expenses.
Please be aware that your visit to a Delta Dental Premier provider or out-of-network provider will result in a greater out-of-pocket expense for you. To find a Delta Dental PPO™ provider in your area, select the Find a Provider tab on this page to search for a Delta Dental PPO™ provider.
Using Delta Dental will be hassle-free. If you have the Carpenters' Plan dental coverage and need an identification card or help locating a network provider, please contact Carpenters' Member Services at 314.644.4802 or toll-free at 877.232.3863 or by email at benefits@carpdc.org.