Employee Benefits Guide 2025-2026

DENTAL BENEFITS

Benefit Summary

In-Network

Calendar Year Deductible Waived for Preventive

$50 Individual $150 Per Family

Annual Maximum

$1,750

Preventive Care  Bitewing X-Rays - as required  Emergency Palliative Treatment  Full-Mouth X-Rays - once in any 24-months  Oral Examinations & Cleanings - twice in any benefit period  Sealants - under age 19, once in 5 years  Space Maintainers - under age 19  Topical Fluoride - under age 19, twice in any benefit period

100%

Basic Care  Fillings  Endodontics / Periodontics  General Anesthesia  Simple / Surgical Extractions  Stainless Steel Crowns

80%

Major Care  Bridges – once every 7 years  Crowns, Inlays, Onlays – once every 7 years

50%

 Dentures – once every 5 years  Implants – once every 5 years Orthodontia – All Participants Lifetime Maximum

50% $1,750

24/7 online access to benefits and service - Register today! Visit www.DeltaDentalSC.com/Members/Register to receive electronic delivery of your benefit information. Once registered, log in to your account online or with the Delta Dental Mobile App.  Order or print an ID card  View your Explanation of Benefits (EOB)  Get answers to frequently asked questions  Review and print your dental plan’s coverage levels, deductibles, maximums, age limits and limitations  Verify your eligibility  Request or download a claim form

Delta Dental Mobile App Use the mobile app to access:  Your Mobile ID card  Coverage and claims information  Find a dentist  Dental Care cost estimator

Scan To Download Delta Dental Mobile

See page 30 for employee premiums

CONMB Employee Benefit Guide 2025

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