Enrollment Information

Dental Coverage

The following chart summarizes the Delta Dental benefits for the Dental plan offered to all eligible employees.

Benefit

In-Network
(PPO & Premier)
Out-of-Network
Annual Deductible (Calendar year)
(waived for Preventive & Diagnostic)
$50/Individual
$150/Family
$100/Individual
$300/Family
Annual Maximum (Calendar year)
$1,000/Person Maximum Benefit Payable
Preventive & Diagnostic Services
Oral Exam, X-rays, Cleanings
No Charge
20%
Basic Services
Fillings, Extractions
No Charge
20%
Periodontics (Gum Treatment)
No Charge
20%
Endodontics (Root Canals)
No Charge
20%
Major Services
Crowns, Dentures, Bridges
40%
50%
Orthodontia – Lifetime Maximum
Child/Adult Coverage
50% to $1,000 Lifetime Benefit
Dental Preferred Provider Organization (DPPO):
  • When visiting an out-of-network dentist, please remember that you are responsible for amounts in excess of charges above the allowable amounts. Out-of-network dentists are not contracted with the carriers; therefore, members may expect to pay more for utilizing a dentist outside of the network.
  • A pre-determination of benefits is recommended for treatment plans that amount to $300 or greater so you can make an informed decision.
Explore all Benefits

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