Delta Dental Plan

July 1, 2008 - July 1, 2009

Information provided is in summary format.  Any difference between the summary provided and actual contract will be settled in favor of the contract.

Deductible

$25 individual/$75 family

Preventive

Plan pays 100%

(Evaluations, examinations, prophylaxes, x-rays, and fluoride treatment)

Basic

Plan pays 80%

(Extractions, dental surgery, endodontic services, root canals, periodontics, restorative fillings, and emergency treatment to temporarily relieve pain)

Major

Play pays 80%

(Major restorative services, crowns, bridges and dentures)

Annual Maximum

$1,500 per member per calendar year for all services

Orthodontia

Not Covered