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Human Resources

Dental Insurance

Print friendly Modified January 15, 2014
Your Coverage Options

Delta Dental offers two plan options — a Base Plan and High Plan. The table below will help you compare your two options.

You’ll see that both plans cover preventive services, like routine checkups and cleanings, as well as basic and major services. However, there are important differences in annual benefit maximums, orthodontia coverage levels, and the percentage of payment for major services, so be sure to compare your options and choose the best fit for your needs and budget.

Delta Dental Base Plan Delta Dental High Plan
In-network Out-of-network In-network Out-of-network
Annual Maximum $1,000 per person* $1,500 per person*
Deductible (Single/Family) $50/$150 $50/$150 $50/$150 $50/$150
Diagnostic/preventive services* 100% 100% 100% 100%
Basic benefit services 80% 80% 80% 80%
Major services** 50% 50% 80% 80%
Orthodontia (child and adult) No coverage 80% 80%
Lifetime orthodontia maximum NA $1,000

* Preventive and diagnostic services don’t count toward the annual maximum.
** Benefit limits on full replacement of existing dentures or crowns apply.

Provider Search

For more information on your dental options, check out this Dental at-a-glance overview, Summary Plan Document and Dental rates.

Delta Dental Networks

The Chart below shows the difference in the amount you will pay for a crown if you use the three different network options for the two Delta dental plans. Using a PPO network dentist (column 1) means you pay the least amount for your crown. Using a Premier network dentist (column 2) saves you money over using an out-of-network Non-Delta dentist (column 3). Please note the examples may not reflect the actual cost for this procedure at your dentist office.

Base Plan:
Delta Dental Plan
Service Code:
D2750
PPO Dentists
PPO Fee Schedule
Premier Dentists
Avg. Premier Fee
Non-Delta Dentists
80th percentile*
Dentist Charge $1,178.00 $1,178.00 $1,178.00
Plan Allowance $682.00 $916.00 $1,000.00
Payment at 50% $341.00 $458.00 $550
Patients Share $341.00 $458.00 $728.00
$550 + $128
High Plan:
Delta Dental Plan
Service Code:
D2750
PPO Dentists
PPO Fee Schedule
Premier Dentists
Avg. Premier Fee
Non-Delta Dentists
90th percentile*
Dentist Charge $1,178.00 $1,178.00 $1,178.00
Plan Allowance $682.00 $916.00 $1,100.00*
Payment at 80% $545.60 $732.80 $880.00
Patients Share $136.40 $183.20 $290
$220 + $78