9 CITY OF LAMAR SERVICES DENTAL PLAN A IN-NETWORK & OUT-OF-NETWORK DENTAL PLAN B IN-NETWORK & OUT-OF-NETWORK Calendar-Year Deductible $50 per person; $150 family limit $50 per person; $150 family limit Calendar-Year Benefit Maximum $1,500 $1,500 Preventive Dental Services (cleanings, exams, xrays, spacers and other preventive services) 100% covered; no deductible 100% covered; no deductible Basic Dental Services (simple extractions, fillings, root canal therapy, oral surgery with general anesthesia or IV sedation) 20% after deductible 20% after deductible Major Dental Services (crowns, inlays, onlays, bridges, dentures, other select prosthodontic services) 50% after deductible Not Covered Orthodontia Services (covered to age 19) 50% to $1,000 lifetime maximum Not Covered Administered by County Health Pool (CHP)—Anthem Network Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. The City of Lamar offers competitive benefits designed to provide high quality dental care. You and your family members may visit any licensed dentist but will receive the greatest out-ofpocket savings if you see an in-network dentist. If you choose to see an out-of-network dentist, you will incur additional out-ofpocket expenses, and you may be billed for the difference in the cost of the services (called balance billing). When you see an in-network dentist, you are protected from balance billing. To find out if your dentist is in-network or to verify your dental coverage, contact Anthem Customer Service at (855) 769-1467 or visit www.anthem.com. DENTAL BENEFITS For additional plan information and benefits, please review the dental plan documents.
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