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International Union of Operating Engineers: Local 399
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Dental Benefits

 


Summary of Dental Benefits

 

Effective February 1, 2015


 

Dental Benefits     Delta Dental PPO Provider             Out of Network Provider
         
Preventative (Routine)   100%   50% of R&C
         

Calendar Year Maximum

 

 

$1500 
Orthodontia not included

   
         
Deductible                      
         

Restorative/Replacement

                     $50 for Restorative/Replacement 
     

Orthodontia
(dependent children only)

        50% to $1000 lifetime maximum per dependent child  



How to file a Dental Claim

Send all dental claims to:

Delta Dental of Illinois

P.O. Box 5402, Lisle, IL 60532

 

Inform your Dentist to refer to Group #20126

 

For additional Dental Benefit information, please refer to

pages 15-17 of your 2015 Summary Plan Description Book
 

 

Click here to download a copy of our
2019 Summary Plan Description Book