The AdapTable Program

Cost-saving products that help your employees
budget for their annual dental costs.

This product can lower monthly payments for employer and employee alike. Program guidelines vary depending upon group size and employer contribution. Minimum enrollment may be more than 10 for voluntary programs. Contact your local Delta marketing office for more information.

The AdapTable program includes these highly-desired features:

Freedom of Choice. Delta Dental Insurance Company is a member of Delta Dental Plans Association whose 37 member companies cover more than 30 million enrollees nationwide. Three-fourths of all licensed dentists in the U.S. participate in the Delta network. However, enrollees are free to select any dentist at any time.

Special advantages from Delta dentists. When you visit a Delta dentist, there are no claim forms to fill out. Table allowances are pre-established by Delta, and employees are responsible only for the difference between their table allowance and the dentist's approved fee, plus the deductible and any amount exceeding the annual dollar maximum. (Delta pays these dentists directly, so there's no waiting for reimbursement.)

Predictable coverage. Employees know their exact coverage in advance. They receive a complete table of allowances, listing what their program pays.

The AdapTable program offers a broad range of covered benefits:

• Diagnostic and preventive services include procedures to assist the dentist in determining required treatment (e.g., x-rays), prophylaxis (cleaning), topical application of fluoride solutions and space maintainers. *
  
  
• Restorations and denture repairs, including amalgam, synthetic porcelain, plastic restorations (fillings) and prefabricated stainless steel restorations for treatment of carious lesions (visible destruction of hard tooth surface resulting from the process of decay), procedures for the repair of partial or complete dentures, and sealants (to seal developmental grooves and pits in teeth for the purpose of preventing decay).
  
  
• Other basic services, including oral surgery; extractions and certain other surgical procedures, including pre-and-post-operative care, general anesthesia when administered by a dentist for a covered oral surgery procedure; endodontics (treatment of the tooth pulp) and periodontics (treatment of gums and bones supporting the teeth).
  
  
• Crowns and prosthodontics, including crowns and cast restorations for treatment of carious lesions when teeth cannot be restored with amalgam or synthetic porcelain or plastic restorations, and procedures for construction of fixed bridges, partial or complete dentures and repair of fixed bridges.

This is a summary of benefits. For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the policy may be continued in force, see your insurance agent or write to the company.

Standard programs are available with variations in deductibles, maximums and eligibility periods. Contact your local Delta Dental marketing office for applicable tables and rates.

The maximum allowances listed in the tables represent the maximum Delta will pay for services. Delta will actually pay the lesser of:

• Delta's maximum plan allowance,
  
  
• The dentist's filed fee,
  
  
• The fee actually charged, or
  
  
• The maximum allowance listed in the table.

When visiting a Delta dentist, the patient is only responsible for the difference between Delta's allowance and the dentist's approved fee.

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