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Benefits

Dental Benefits

Coverage offered through Delta Dental PPO PlusPremier Network

With your PPO plan you have the freedom to visit any dentist you choose.  If you opt to use an In-Network Delta provider, however, the fees for services will be discounted and therefore you will pay less than if using an Out-of-Network Provider.

Click here to download the Delta Dental claim form.

Dental Educational Resources

Monthly Contributions

Employee Only: $10
Employee + One: $25
Family: $25

The cost of enrolling in the plan is deducted from your pay on a pre-tax basis.

Dental Plan Summary

This chart summarizes the benefits provided under the Delta Dental PPO Plan. For more detailed information, please refer to your summary Plan description.

  Delta Dental PPO Plus Premier
  In-Network Out-of-Network
Calendar Year Deductible*
(Waived for Diagnostic, Preventive and Orthodontic Care)
   
Individual $50 $50
Employee + One $100 $100
Family $150 $150
Calendar Year Maximum* $2,000/person $2,000/person
Preventative Care (Twice Per Calendar Year)
Includes exams, cleanings, x-rays, fluoride treatments for children, emergency treatment, space maintainers, sealants
100% 100%
Basic Care
Includes laboratory tests, fillings (amalgam, silicate, acrylic), root canal, repair and relining of dentures, repair and recementation of bridgework and crowns, oral surgery, posterior composites, surgical and non- surgical periodontics
80% 80%
Major Care
Includes porcelain fillings and crowns, installation of bridgework, dentures and crowns, implants, prosthodontic services
60% 60%
Orthodontia** 50% 50%
Orthodontia Lifetime Maximum* $2,000/child $2,000/child

*In- and Out-of-Network combined
**Orthodontic services limited to participants through age 18.