b'Healthcare ElectionsDENTALCOVERAGECarnegieofferstwodentalplansthroughDeltaDental,eachwithdifferentcoveragelevelsand maximum benefits. The plans are the Dental HMO and the Dental PPO.The Dental PPO has 3 tiers of coverage with the best level being with Delta PPO providers. There is a separate Delta Premier PPO network, but the patient responsibility may be higher due to a different allowable fee. On out-of-network dentists, the member is responsible up to the full charge.Delta Dental HMO Delta Dental PPODHMO In-network Only Delta PPO|Delta Premier PPO|Out-of-Network Two in-networks of coverage: PPO and Premier PPO.In-Network dentists only Search for participating doctors in both networks. Basic fee-for-service planOut-of-network coverage available, but only up to Plan Highlights allowed benefit. Member can be balance billed. A dentist must be selected, Highest annual maximum benefit.either by you or by Delta DentalIncludes orthodontia coverage.Plan Year Deductible None $50 Individual | $100 FamilyAnnual Plan Year None $1,000 per person per yearMaximum BenefitAmounts shown are the coinsurance amounts the plan paysPreventive Care 100% N/A 100% 100% 100%(cleanings, exams and X-rays)Regular Restorative Care Fee Schedule N/A 80% 80% 80%(fillings and root canals)Major Restorative Care(dentures, bridgework, andFee Schedule N/A 60% 60% 60%crowns)Orthodontia Fee Schedule 50% Lifetime maximum of Not Covered(braces and retainers) $1,500 per personDental Benefit Costs (These costs are per pay period)Employee Only $9.62 $17.32Two-Party $15.93 $30.95Family $23.52 $53.339'