Overview of 2016 Dental Benefits Delta Dental of California provided to Retiree groups by Delta Dental of California

No I.D. Cards. No claim forms. Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated No I.D. Cards. No claim forms. Locate a Delta dentist by visiting deltadentalca.org or calling 1-800-427-3237. Make an appointment and tell the dentist you are a Delta member. Bring the name of your employer (Salinas Union H.S. District) and Group Number (1317-0013) with you.

You can keep your dental expenses down by: Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated You can keep your dental expenses down by: Comparing the fees of different dentists; Using a Delta dentist; Having your dentist obtain predetermination from Delta for any treatment over $300.00; Visiting your dentist regularly for checkups; Following your dentist’s advice about regular brushing and flossing; Avoiding putting off treatment until you have a major problem.

Calendar Year Benefit Maximums Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Calendar Year Benefit Maximums Diagnostic, Preventive, Basic, Restorative, and Prosthodontic: $1,500.00 (non PPO dentist) for each enrollee. $2,000.00 (PPO dentist) for each enrollee Dental Accident: $1,000.00 for each enrollee; this Benefit is separate from the other Benefits. Lifetime Benefit Maximums Orthodontic: $1,000.00 for each enrollee.

Increasing Benefits Program Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Increasing Benefits Program Delta will pay 70% of the Covered Fees for the Diagnostic, Preventive, Basic, Crown, and Restorative Benefits during the first (1st) year of eligibility; This percentage increases 10% each consecutive year the dentist is visited to a maximum of 100%; If you don’t visit your dentist in any calendar year, the percentage remains at the level you reached the previous year; If you reestablish eligibility after losing it, the percentage returns to 70%.

Diagnostic Benefits (70%-100%) Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Diagnostic Benefits (70%-100%) Oral examinations (maximum of two (2) in any calendar year); x-rays (once every three (3) years; bitewing x-rays once in any calendar year to adults- two (2) times a year to children); diagnostic casts; examination of biopsied tissue; palliative (emergency) treatment of dental pain; specialist consultation.

Preventative Benefits (70%-100%) Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Preventative Benefits (70%-100%) Prophylaxis (cleaning); fluoride treatment; space maintainers.

Basic Benefits (70%-100%) (slide 1 of 5) Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Basic Benefits (70%-100%) (slide 1 of 5) Oral Surgery: extractions and certain other surgical procedures, including pre- and post-operative care;

Basic Benefits (70%-100%) (slide 2 of 5) Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Basic Benefits (70%-100%) (slide 2 of 5) Restorative: amalgam, silicate, or composite (resin) restorations (fillings) for treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay);

Basic Benefits (70%-100%) (slide 3 of 5) Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Basic Benefits (70%-100%) (slide 3 of 5) Endodotic: treatment of the tooth pulp; Periodontic: treatment of gums and bones that support the teeth;

Basic Benefits (70%-100%) (slide 4 of 5) Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Basic Benefits (70%-100%) (slide 4 of 5) Sealants: topically applied acrylic, plastic, or composite material used to seal developmental grooves and pits in teeth for the purpose of preventing dental decay (limited to eligible dependent children under the age of fourteen(14)) not including the repair or replacement of a sealant on a tooth within three (3) years of its application;

Basic Benefits (70%-100%) (slide 5 of 5) Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Basic Benefits (70%-100%) (slide 5 of 5) Adjunctive General Services: general anesthesia; office visit for observation; office visit after regularly scheduled hours; therapeutic drug injection; treatment of post-surgical complications (unusual circumstances); limited occlusal adjustment.

Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Crowns, Jackets, Inlays, Onlays, and Cast Restoration Benefits (70%-100%) Benefits only if they are provided to treat cavities which cannot be restored with amalgam, silicate, or direct composite limited to once every five years on the same tooth unless replacement is required because the restoration is unsatisfactory due to poor quality of care or extensive loss of tooth structure or supporting tissue since the replacement of the restoration.

Prosthodontic Benefits Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Prosthodontic Benefits Construction or repair of fixed bridges, partial dentures, and complete dentures if provided to replace missing, natural teeth once every five (5) years unless there has been such an extensive loss of remaining teeth or a change in supporting tissue that the existing appliance cannot be made satisfactory. (Paid at 70% every year with no increasing annual level of benefit.)

Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Orthodontic Benefits Procedures using appliances or surgery to straighten or realign teeth, which otherwise would not function properly. (Paid at 50% every year with no increasing annual level of benefit to a lifetime maximum of $1,000.00.)

Dental Accident Benefits Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Dental Accident Benefits Any services which would be covered under other Benefit categories when they are provided for conditions caused directly by external, violent, or accidental means. (Paid at 100% every year with an annual maximum of $1,000.00.)

Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Rates (effective 4/01/2016) Single $42.83 Two Party $89.69 Family $136.53

Monterey Bay Public Employees Trust Overview of 2016 Dental Benefits (Delta Dental of California) - Certificated Disclaimer This presentation provides only a general overview of your Dental benefits; For complete information, consult your copy of the Combined Evidence of Coverage and Disclosure Form or contact either Delta Dental (1-800-427-3237 or www.deltadentalca.org) or Health Services & Benefit Administrators (1-831-757-1711 or 1-888-742-3380).