Plan-A Nevada Delta Preferred Dental Options

Plan A Nevada Delta Premier Dental Options

Procedures	Delta Premier Preferred Provider Program (DPO)
Procedures	Delta Premier Preferred Provider Program (DPO)
Important information about the Plan	Benefits are paid based on allowable charges. Allowable charges are usual, customary and reasonable fees as determined by Delta Dental. You may use any licensed dentist, but when you use a Delta Dental participating dentist, you are assured that his/her fees are within allowable charge limits. All claims for services rendered must be submitted directly to Delta Dental for processing.
Deductible	$40 per person, per calendar year; $120 maximum per family, deductible does not apply to diagnostic and preventative benefits
Annual Maximum	$2,000 per person per calendar year
Office Visit	Delta pays 80% of allowable charges
Diagnostic Oral Examination, Full Mouth X-rays, Bitewing X-rays, Emergency treatment (during office hours)	Delta pays 80% of allowable charges
Preventive Prophylaxis Topical fluoride Space maintainers	Delta pays 100% of allowable charge
Sealants (per tooth)	Delta pays 80% of allowable chargers (deductible applies)
Periodontic Subgingival curettage, Gingivectomy, Muco-gingival or osseous surgery	Delta pays 80% of allowable charges
Endodontic Pulp capping, Pulptomy, Root Canals, Apicoectomy	Delta pays 80% of allowable charges
Restorative (other than crowns) Amalgram - primary & permanent teeth	Delta pays 80% of allowable charges
Crowns and Bridges Crowns per unit - Full gold Predominately base metal Porcelain Pin Build-up, Post and core	Delta pays 80% of allowable charges
Prosthodontics Dentures - complete or partial, adjustments, reline (office) & rebase	Delta pays 80% of allowable charges
Oral Surgery Simple extractions, Surgical extractions Impactions, Frenectomy	Delta pays 80% of allowable charges
Orthodontia Full Banding Retention Records Fee	Delta pays 80% of allowable charges, up to $1,000 lifetime maximum (child or adult)
TMJ Rider	Delta pays 80% of allowable charges, up to $1,000 lifetime maximum
Emergency Out-of-Area Treatment	Benefits are payable as indicated above

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The information contained on this website is intended to provide only highlights of the benefits available under the Sheet Metal Workers Trust Funds' plans and plans of benefits. Complete details about the plans are contained in the governing plan documents. In the event of any inconsistency between the information on this website and the official plan documents, the terms of the plan documents, as interpreted by the plan's Board of Trustees in its sole and absolute discretion, will control. The respective Boards of Trustees of the plans reserve the right to amend, modify, or terminate all or part of the plans at any time, subject to applicable law.