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International Union of Operating Engineers: Local 399
handw.jpg2017 Summary of Benefits Coverage Document now Available

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
2015 Summary Plan Description Book