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.
Coverage |
Base Plan |
High Plan |
---|---|---|
Employee Only |
$31.98 |
$39.52 |
Employee + Spouse |
$63.96 |
$79.00 |
Employee + Child(ren) |
$60.74 |
$75.08 |
Family |
$102.32 |
$126.46 |
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