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Preventive Dental PPO

The Preventive Dental PPO (DPPO) plan includes most preventive procedures at low or no cost to you, and these services are not subject to the annual maximum. You pay 20% coinsurance on basic restorative services and 99% coinsurance on major restorative services, which are subject to the annual maximum. 

The coverage includes:

  • DPPO Advantage, DPPO, & Out-of-Network Annual Deductible: $0 individual, $0 family
  • Annual Benefit Maximum: $1,500 individual
  • Sealants will be included up to age 14 as a covered preventive service (plan pays 100%)
  • Preventive procedures are not subject to the annual maximum benefit.
Service
Your Cost
Preventive & Diagnostic Services
DPPO Advantage Provider: 0%
DPPO & Out-of-Network Provider: 0%1
Basic Restorative Services
DPPO Advantage Provider: 20%
DPPO & Out-of-Network Provider: 20%1
Major Restorative Services
DPPO Advantage Provider: 99%
DPPO & Out-of-Network Provider: 99%1
Orthodontia
DPPO Advantage Provider: 99%
DPPO & Out-of-Network Provider: 99%1

For detailed descriptions of our three dental plans, download our 2017 Dental Plan Handbook. 2018 handbooks are available in January.

View the plan summaries:

1If the provider’s fees exceed the regular and customary charges allowed in the plan, you may be billed for the balance.

Health benefits are offered through plans maintained by Church Pension Group Services Corporation (doing business as The Episcopal Church Medical Trust), 19 East 34th Street, New York, NY 10016.

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