 Sealants are payable once per tooth per three-year period for first and second permanent molars for people age 15 and under. The surface must be free from decay and restorations. Interim caries arresting medicament application is payable for bicuspids and first and second permanent molars once every three years for people age 15 and under.  Veneers are payable on incisors, cuspids, and bicuspids once per tooth in any five-year period for people age 12 and older when necessary due to fracture or decay.  Composite resin (white) restorations are payable on posterior teeth.  Porcelain and resin facings on crowns are optional treatment on posterior teeth.  Pulpal regeneration is a Covered Service once per lifetime.  TMD treatment, biopsy of oral tissue, sinus augmentation, and bone replacement graft for ridge preservation are Covered Services.  Benefits for Temporomandibular Disorders (TMD) are limited to those services normally provided by a dentist to relieve oral symptoms associated with malfunctioning of the temporomandibular joint. This does not include services that would normally be provided under medical care.  Tissue conditioning is payable once in any 12-month period.  Implants are payable once per tooth in any five-year period. Implant related services are Covered Services.  Crowns over implants are payable once per tooth in any five-year period. Services related to crowns over implants are Covered Services.  Office visits for observation and therapeutic parenteral drug administration are payable without limitation. Cleaning and inspection of dentures is payable twice per calendar year. Complete occlusal adjustments are payable twice per lifetime.  A removable or fixed harmful habit appliance is payable without limitation up to age 14. Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! You can now receive expert dental care when you are outside of the United States through our Passport Dental program. This program gives you access to a worldwide network of dentists and dental clinics. English-speaking operators are available around the clock to answer questions and help you schedule care. For more information, check our Web site or contact your benefits representative to get a copy of our Passport Dental information sheet. Maximum Payment – $1,250 per person total per Benefit Year on all services, except orthodontic services. $1,200 per person total per lifetime on orthodontic services. Payment for Orthodontic Service – When orthodontic treatment begins, your Dentist will submit a payment plan to Delta Dental based upon your projected course of treatment. In accordance with the agreed upon payment plan, Delta Dental will make an initial payment to you or your Participating Dentist equal to Delta Dental's stated Copayment on 30% of the Maximum Payment for Orthodontic Services as set forth in this Summary of Dental Plan Benefits. Delta Dental will make additional payments as follows: Delta Dental will pay 60% of the per monthly fee charged by your Dentist based upon the agreed upon payment plan provided by your Dentist to Delta Dental. Deductible – $25 Deductible per person total per Benefit Year limited to a maximum Deductible of $50 per family per Benefit Year. The Deductible does not apply to diagnostic and preventive services, emergency palliative treatment, brush biopsy, X-rays, sealants, office visits for observation, and orthodontic services. Waiting Period – Certified Employees are eligible for coverage on the 1st of the month following date of hire. Classified Employees are eligible for coverage on the 1st day of the month after meeting the 60 day waiting period for employment. Eligible People – All active full-time & part-time Certified and Classified employees who work 30 or more hours per week (0001), retired teachers who have at least 15 years of service and are at least 55 years of age, retired teachers who have at least 10 years of service and are at least 60 years of age, retired administrators who have at least 10 years of service and are at least 55 years of age, retired classified employees who have at least 15 years of service and are at least 55 years of age, retired classified employees who have at least 10 years of service and are at least 60 years of age (0002) and (Consolidated Omnibus Budget Reconciliation Act of 1985) enrollees (0099), if applicable, who choose the Dental Plan. Also eligible are your Spouse and your Children to the end of the calendar year in which they turn 26, including your Children who are married, who no longer live with you, who are not your dependents for Federal income tax purposes, and/or who are not permanently disabled. The medical and Delta Dental plans are offered as a package. Employees enrolled in either plan are automatically enrolled in both plans with the same type of coverage. For example, employees enrolled with single coverage under the medical plan must also be enrolled with single coverage under the Delta Dental plan. KR#64690433