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Lindbergh Schools

11 

Dental Insurance

Delta Dental of Missouri Plan Designs

Features

High Plan

Base Plan

PPO

Premier

Out-of-

Network

PPO

Premier

Out-of-

Network

Individual Deductible:

$25

$25

$25

$50

$50

$50

Family Deductible:

$75

$75

$75

$150

$150

$150

Type I - Preventive Care:

(Exams, Cleanings)

100%

(No Ded.)

100%

(No Ded.)

100%

(No Ded.)

100%

(No Ded.)

100%

100%

Type II - Basic Proce-

dures: (Fillings, Extrac-

tions)

100%

80%

80%

80%

60%

60%

Type III - Major Proce-

dures: (Caps, Crowns)

80%

50%

50%

60%

50%

50%

Endodontics

100%

80%

80%

80%

50%

50%

Periodontics

100%

80%

80%

80%

50%

50%

Type IV—Orthodontia

50% to $1,500 Lifetime Maximum

50% to $1,000 Lifetime Maximum

Maximum Benefits / Year

$1,500

$1,000

Monthly Employee Cost

Type of Coverage

High Plan

Base Plan

Employee

$0

$0.00

Employee & Spouse

$40.00

$10.00

Employee & Child(ren)

$45.00

$20.00

Employee & Family

$90.00

$55.00