A DELTA DENTAL'

Rollover Max Maximizing your dental benefits.

More value, more benefits. With the Rollover Max dental plan, you and your family members can save and accumulate part of your unused benefit dollars for other dental needs. It's a great way to encourage low-cost preventive services for patients while allowing extra savings for future dental care.

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$300 rolls over to next year

$300 rolls over to next year

$300 rolls over to next year

$1,250 Annual

Maximum $400 paid

dental claims

$1,550 Maximum Rollover $450 paid

dental claims

$1,850 Maximum Rollover $300 paid

dental claims

$2,150 Maximum Rollover

$1,700* paid dental claims

$2,000 Maximum Rollover $300 paid

dental claims

$1,700* Maximum Rollover $250 paid

dental claims

Twin Falls County

Dental Benefits Rollover Max- PPO 50

es Max Fact

With Rollover Max, when you use less than the $600 threshold amount in total paid dental claims during the year, a portion of your benefit dollars will automatically rollover for future years when you may need it most. It's a fantastic benefit you can put to work in many ways to benefit your dental health.

Categories

Plan Name

Network Type

Preventive & Diagnostic

Basic

Major

Deductible*

Annual Maximum based on a calendar year

Maximum Rollover

Annual Threshold Amount in total paid claims

Maximum Rollover

Child Orthodnotia

Lifetime Maximum

Delta Dental PPO

PPO 50 Rollover Max

PPO Premier

100% 80%

80% 70%

50% 40%

$50/$150 $50/$150

$1,250 $1,000

$600 $500

$300 $250

Discount Discount

Program Program

'Deductible applies to Basic and Major Services only with a maximum of (3) three deductibles per family

' In year 4, no rollover was accrued because total paid claims exceeded the annual threshold amount. In year 5, $450 was deducted from the maximum rollover amount because paid claims in year 4 exceeded the $1.250 annual maximum by $450 .

Getting the most from Rollover Max

• When you receive a preventive service (such as a dental cleaning or dental exam) within the calendar year, you will be eligible for the rollover benefit.

• You are eligible for the$3,050 or $2,500 maximum rollover benefit when you obtain ALL dental services from a PPO or Premier dentist.

• If you receive care from a non-participating dentist at any time during the benefit year, you will not accrue the rollover benefit for that year.

• You will lose your rollover balance if you dis-enroll or have a break in coverage.

• The maximum rollover amount does not apply to any services with a lifetime maximum. (such as orthodontics or implants). 6 DELTA DENTAL