b'Healthcare ElectionsDENTAL COVERAGECarnegie offers two dental plans through Delta Dental, each with different coverage levels and maximum benefits. The plans are the Dental HMO and the Dental PPO.The Dental PPO provides two ways to access in-network dentists: Delta PPO Network and Delta Premier PPO Network. These providersareallcontractedwithDeltaDentalandarein-network.Theplanalsooffersout-of-networkcoverage. Whenusingout-of-network dentists, the member is responsible for the full cost of services.Delta Dental HMO Delta Dental PPODHMO In-Network Only Delta PPODelta Premier PPOOut-of-Network Two in-networks of coverage: PPO and Premier PPOIn-network dentists only Network. Search for participating doctors in bothBasic fee-for-service plan networks.Plan HighlightsYou must select a dentist or Out-of-network coverage available, but only up to Delta Dental will select for you. the allowed benefit. Member can be balance billed. Orthodontia coverage for adults and children.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(cleanings, exams and X-rays) 100% N/A 100% 100% 100%Regular Restorative Care Fee Schedule N/A 80% 80% 80%(fillings and root canals)Major Restorative Care Fee Schedule N/A 60% 60% 60%(dentures, bridgework, and 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 $9.75 $17.32Two-Party $16.14 $30.95Family $23.85 $53.337'