Dental
Regular dental care is essential to good health. Leaf Home provides you with an opportunity to purchase Dental coverage through Delta Dental. You are eligible for this benefit after completing 30 days of employment.
SUMMARY OF DENTAL BENEFITS
In-network vs. Out-of-network
The Leaf Home Dental Plan is designed to provide the dental coverage you need with the features you want. Take advantage of what this plan has to offer without compromising what matters most – including the freedom to visit the dentist of you and your dependents choice – an “in-network” dentist or an “out-of-network” dentist.
For the best savings, use a Delta Dental provider. You can find a dentist by visiting the Delta Dental website. Just show your dental plan card when you visit the dentist. If you choose a dentist who does not participate in our dental plan, your out-of-pocket expenses may be more, since you will be responsible for paying any difference between the dentist’s fee and the plan’s payment for the approved service.
Be prepared and plan ahead
If dental work is required, request a pretreatment estimate from your dentist. Your dentist will contact Delta Dental. You and your dentist can review your care and costs before treatment. It is a great way to be prepared and plan ahead.
Dental Benefits
| YOUR DENTAL PLAN AT A GLANCE | Delta Dental PPO Dentist | Delta Dental Premier Dentist | Out-of-Network |
|---|---|---|---|
| Annual Benefit Maximum - Per insured person | $1,000 | $1,000 | $1,000 |
| Diagnostic & Preventive Maximum Annual Maximum Carryover | No | No | No |
| Orthodontic Lifetime Benefit Per eligible insured child | $1,000 | $1,000 | $1,000 |
| Annual Deductible - Per insured person | $50 | $50 | $50 |
| Family maximum | 3x single member deductible | 3x single member deductible | 3x single member deductible |
| DENTAL PPO ALL EMPLOYEES | Delta Dental PPO Dentist (Delta Pays) | Delta Dental Premier Dentist (Delta Pays) | Out-of-Network |
|---|---|---|---|
|
Diagnostic and Preventive Services Periodic oral exam Teeth cleaning (prophylaxis) |
100% coinsurance | 100% coinsurance | 100% coinsurance |
|
Basic Services Amalgam (silver-colored) filling Front composite (tooth colored) filling |
80% coinsurance | 80% coinsurance | 80% coinsurance |
|
Endodontics Root Canal |
50% coinsurance | 50% coinsurance | 50% coinsurance |
| Periodontics Scaling and root plane |
50% coinsurance | 50% coinsurance | 50% coinsurance |
|
Oral Surgery Surgical extractions |
50% coinsurance | 50% coinsurance | 50% coinsurance |
| Major Services Crowns |
50% coinsurance | 50% coinsurance | 50% coinsurance |
|
Prosthodontics Dentures Bridges Dental Implants (Covered) |
50% coinsurance | 50% coinsurance | 50% coinsurance |
| Prosthetic | 80% coinsurance | 80% coinsurance | |
| Orthodontic Services Dependent Children to 19 |
50% coinsurance | 50% coinsurance | 50% coinsurance |
Delta Dental PPO
Delta Dental of Ohio
