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Dental

BMO offers comprehensive dental coverage through Delta Dental, which Delta Dental of Illinois administers.

You can see any dentist you want, however, you can save money when you go to a dentist in the Delta Dental PPO or Delta Dental Premier network.

Here’s a high-level overview of the Dental Plan. For details, review the Dental SPD.

Features
Annual Benefit Maximum	$2,000 per person
Lifetime Non-surgical TMJ Maximum	$1,000 per person
Finding a doctor	You’ll maximize your benefits by receiving care from a Delta Dental PPO or Delta Dental Premier network dentist: Delta Dental PPO: Lowest out-of-pocket costs and network protection Delta Dental Premier: Higher out-of-pocket costs than PPO, but may be lower than non-network and network protection Non-network: You may have the highest out-of- pocket costs Non-network dentists have not agreed to accept Delta Dental’s reduced fees as payment in full. Payment is based on the lesser of the Delta’s usual fee or maximum plan allowance. Non-network dentists can charge amounts exceeding the maximum plan allowance.
	What You Pay
Annual Deductible	Individual coverage: $50 Family coverage: $150
Preventive Services Routine exams (two per calendar year) Cleanings (two per calendar year) X-rays (bitewings — one set per calendar year; full mouth — once every three years) Fluoride treatments (twice per calendar year for dependents under age 19) Space maintainers Sealants	$0
Basic Services Fillings (amalgam and composite on front teeth) Posterior composites Emergency exams & pain relief Treatment Endodontics Periodontics Simple extractions Oral surgery General anesthesia (in conjunction with oral surgery) Denture relines, repairs, rebase and adjustments to dentures	20%
Major Services Partial/full dentures Fixed/removable bridges Implants Cast restoration-crowns, onlays, post and core Non-surgical TMJ	50%
Orthodontic Care Up to $2,000 separate lifetime maximum per individual, up to age 19	50%

Enhanced Benefits Program

The Delta Dental Enhanced Benefits Program integrates medical and dental care for individuals with specific health conditions.(e.g., diabetes, kidney failure, periodontal disease, pregnant women). Here’s what you need to do to enroll in the program:

Sign into Member Connection on Delta Dental
Select the Enhanced Benefits tab
Enter health information for you or your dependents to qualify for the extra benefits

Enhanced Benefits Program

The Delta Dental Enhanced Benefits Program integrates medical and dental care for individuals with specific health conditions.(e.g., diabetes, kidney failure, periodontal disease, pregnant women).

Here’s what you need to do to enroll in the program:

Sign into Member Connection on Delta Dental
Select the Enhanced Benefits tab
Enter health information for you or your dependents to qualify for the extra benefits