Comparison of Dental Plans

*Healthy and Well Kids in Iowa(hawk-i)*
Comparison of Dental Plans
This is a comparison of the particpating dental plans with the *hawk-i* program. This is only a summary of benefits. If more information is needed, please contact the plan as listed below.

	Delta Dental	John Deere
Benefits	All your Delta Dental benefits are covered at 100%. Benefits include: Dental cleanings and exams Topical fluoride applications X-rays, full mouth Sealants Space maintainers Emergency treatment General anesthesia/sedation Cavity repair, fillings Oral surgery and extrations Root canals Periodontics Crowns Bridges and dentures, including repairs	Preventive & Diagnostic Examinations Cleanings Fluoride treatment for children under age 18 X-rays - routine bitewing X-rays - full mouth Sealants Primary Services Fillings Root Canals Periodontics Oral Surgery Major Services Crowns Dentures Bridgework
Benefit Maximum	$1,000 annually	$1,000 per calendar year
Participating Providers	Any Delta Premier USA dentist. Approximately 93% of Iowa dentists participate with Delta Dental and a listing can be found on the web page at www.deltadental.com. In addition, a provider directory will be included in your enrollment packet.	Open Access: You may see any licensed dentist.
Limitations	Examinations - twice per calendar year Cleanings – twice per calendar year Topical Fluoride Applications - once every 12 months Bitewing X-rays - once every 12 months Full Mouth X-rays - once every 5 years Sealants (children under age 19) - once per permanent first and second molars per lifetime. Space Maintainers (children under age 19) Periodontics – Conservative - once every 24 months Complex - once per calendar year Cast Restorations – once every 5 years Prosthetics (Dentures/Bridges) – once every 5 years No benefits will be paid if services are provided by a non-participating dentist. No orthodontia (braces) coverage	Examinations - once every 6 months Cleanings - once every 6 months Fluoride Treatment (children under age 18) - once every 6 months Routine Bitewing X-rays - once every 12 months Full Mouth X-rays - once every 36 months Sealants - one time per tooth (up to age 10 for first molars; by age 15 for second molars) No orthodontia (braces) coverage
Contact Information Phone: Web Site:	(800) 544-0718 (TDD 888-287-7312) www.deltadentalia.com	John Deere Health Customer Services: (800) 747-1446 www.johndeerehealth.com Customer service phone numbers are in the back of your member handbook.