Marathon Petroleum Company LP

Introduction: We offer dental coverage through the Marathon Petroleum Dental Plan (the Dental Plan). Under the plan, you can receive care from any licensed dentist; however you will save money when you visit a dentist in the Delta Dental network, since these dentists have agreed to give plan members the largest discounts.

Active Employees Dental Plan

When you visit a network dentist, the plan pays all or a portion of the negotiated cost of the service. When you visit an out-of-network dentist, the plan pays all or a portion of the Reasonable and Customary (R&C) charge^*.

Delta Dental PPO and Premier Networks
Annual Deductible: $50 per person
Calendar Year Maximum (not including orthodontia): $2,000 per person
Type of Service	Service Examples	Coverage
Preventive and Diagnostic	Exams (limited to two per year), x-rays	100%^*† (no deductible)
Basic Dental Services	Fillings, extractions, root canals	80%^* (after deductible)
Major Dental Services	Inlays, crowns, dentures	50%^* (after deductible)
Orthodontia Services (lifetime maximum: $2,000 per person)	Traditional Metal Braces	50%^* (after deductible)

^*Of Reasonable and Customary (R&C) Charge when using an out-of-network provider. R&C is determined by the average usual charge for a given procedure charged by most dentists in a given geographic area.

^†$50 individual deductible does not apply to preventive services.

Active Employees Dental Plan Rates

2021 Dental Plan Monthly Employee Contributions (pre-tax payroll deductions)
	Employee Only	Employee + Spouse	Employee + Children	Employee + Family
Delta Dental	$13.50	$27.50	$31.00	$48.00

Pre-65 Retirees Dental Plan

In the Pre-65 Retiree Dental Plan you can receive care from any licensed dentist. However, providers in the Delta Dental PPO network offer the greatest cost savings. Providers in the Delta Dental Premier network also offer large discounts but may balance bill you for charges not paid by the plan.

^* This Plan is not open to new enrollment. Please check with the Benefits Service center on your eligibility.

Dental Plan PPO
Annual Deductible: $50 per person
Calendar Year Maximum: $1,000 per person
Type of Service	Service Examples	Coverage
Preventive and Diagnostic	Exams (limited to two per year), x-rays	100%^*† (no deductible)
Basic Dental Services	Fillings, extractions, root canals	80%^* (after deductible)
Major Dental Services	Inlays, crowns, dentures	50%^* (after deductible)
Orthodontia Services	Not covered	Not covered

^*Of Reasonable and Customary (R&C) Charge when using a Premier Network or an out-of-network dentist. R&C is determined by the average usual charge for a given procedure charged by most dentists in a given geographic area.

^†$50 individual deductible does not apply to preventive services.

Pre-65 Retirees Dental Plan Rates

Retirees under age 65 are eligible for dental coverage that is similar to the coverage provided to MPC active employees. The individual calendar year maximum is different for pre-65 retirees, and so are the contribution amounts for coverage. For information on monthly contributions for COBRA coverage under the active dental plan, see COBRA Rates.

Under this Plan, you are encouraged to receive care from a dentist in the Delta Dental PPO Network, or the Delta Dental Premier Network.

Pre-65 Retiree Dental Plan – 2021 Monthly Contributions
Retiree Only	Retiree + Spouse	Retiree + Children	Retiree + Family
$23	$46	$51	$77

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