The PPO plan offers a variety of benefits with set reimbursement amounts. You pay the provider for services at the time of your appointment. Claim payments are then made to you or your provider. The plan features:

• Freedom to choose any dentist
• Quick claims turnaround
• National coverage
  
  
  

Type I - Diagnostic & Preventive Services	Reimbursement
	In Network	Out of Network*
Oral Exam Prophylaxis Topical Fluoride X-Rays Sealants Space Maintainers	100%	80%
Type II - Basic Services	Reimbursement
	In Network	Out of Network*
Simple Restorative Emergency Palliative Treatment Tooth Extraction Endodontics	80%	60%
Type III - Major Services	Reimbursement
	In Network	Out of Network*
Major Restorative Bridge, Denture Repair Prosthetics Periodontics	50%	50%
Type IV - Orthodontics
	In Network	Out of Network*
Dependent children 18 years of age or younger	50%	50%
MAXIMUM BENEFITS
	In Network	Out of Network*
Lifetime     Type I, II, III     Type IV Calendar Year Maximum (per person)    Type I, II, III    Type IV Deductible per person; maximum 3 per family    Type I    Type II, III, IV Waiting Periods    Type I, II, III, IV	Unlimited $1000   $1200 $1000 None $50 None	Unlimited $1000   $1200 $1000 None $50 None

This schedule shows only a few of the covered procedures. Please see your Benefit Administrator for a complete schedule. This schedule is intended for comparison purposes only. The benefits for each plan will be determined by the contract. For a complete listing of benefits and exclusions and limitations, please reference your certificate of coverage.

To submit comments or questions, please visit our Contact Center.

© Copyright CompBenefits 2006-2008.