Human Resources - Benefits

Administration Division

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Dental

Benefit

Delta Dental Base Plan

Delta Dental High Plan

In-network

In-network

Annual maximum benefit

$1,000 per person *

$1,500 per person *

Deductible (Single/Family)

$50/$150

$50/$150

Diagnostic/preventive services *

100%

100%

Basic benefit services

80%

80%

Major benefit services **

50%

80%

Orthodontia (child and adult)

No coverage

80%

Lifetime orthodontia maximum

n/a

$1,000

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

How are orthodontic claims paid?

  • Delta Dental Base Plan: No orthodontic coverage.
  • Delta Dental High Plan: The first payment is 50% of the total amount payable. The remaining 50% is paid 12 months later. Allowances for orthodontic procedures include all appliances, adjustments, insertion, removal and post treatment stabilization (retention). Calculations are based on the all-inclusive total treatment plan amount (subject to any deductible), the appropriate payment percentage and maximum amount.
Delta Dental monthly premiums

Coverage

Base Plan

High Plan

Employee Only

$31.80

$39.04

Employee + Spouse

$63.18

$78.04

Employee + Child(ren)

$60.00

$74.16

Family

$101.06

$124.90

Icon of a blue tooth representing the dental provider options.

Find a dental provider
Save when you choose an in-network dentist.

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