The following chart summarizes the benefits for the dental plan offered to all eligible employees.
Dental Preferred Provider Organization (DPPO):
Dental Preferred Provider Organization (DPPO)
Visit MutualofOmaha.com/dental to find participating dental providers. If you see an out-of-network dentist, please be aware that you will be responsible for any costs that exceed the allowable amounts. Since out-of-network dentists are not contracted with the carrier,
you may end up paying more for services.
For treatment plans costing $300 or more, it’s recommended to request a pre-determination of
benefits so you can make an informed decision.
In-Network | Out-of-Network |
|
|---|---|---|
| Annual Deductible | $50/Individual $150/Family | $50/Individual $150/Family |
| Annual Maximum | $1,250/Person | $1,250/Person |
| Preventive & Diagnostic Services | ||
| Oral Exam/Bitewing, X-rays | No charge | 20% |
| Cleanings | No Charge | 20% |
| Basic Services | ||
| Fillings | 20% | 40% |
| Extractions | 20% | 40% |
| Periodontic Treatment (Deep Cleaning) | 20% | 40% |
| Endodontic Treatment (Root Canals) | 20% | 40% |
| Major Services | ||
| Crowns | 50% | 60% |
| Dentures | 50% | 60% |
| Bridges | 50% | 60% |
| Orthodontia – Lifetime Maximum | ||
| Child Coverage | 50% up to $1,250 | 70% up to $1,000 |
Explore all Benefits