Dental Plan

It’s important to have regular dental exams and cleanings so problems are detected before they become painful — and expensive. Keeping your teeth and gums clean and healthy will help prevent most tooth decay and is an important part of maintaining your overall health. We offer two dental plan options through Delta Dental.

Dental ID Cards:

Delta Dental mails ID cards upon your initial enrollment on the dental plan.
Identifying information does not change, therefore dental ID cards are not mailed each renewal.
If you would like a new dental ID card mailed to you:
- Call Delta Dental at 1.800.524.0149
- Request a new ID card on the Delta Dental portal at www.deltadental.com

	Base Plan	Buy-Up Plan
Annual Deductible (Individual/Family)	$50/$150	$50/$150
Calendar Year Maximum	$1,500 per individual	$1,500 per individual
Orthodontia Lifetime Maximum	$1,500 per individual	$1,500 per individual
Diagnostic and Preventive Services (e.g., X-rays, cleanings, exams)	Covered at 100%	Covered at 100%
Basic and Restorative Services (e.g., ﬁllings)	80%	Covered at 100%
Major Services (e.g., dentures, crowns, bridges)	50%	60%
Orthodontia	50%; No age limit	50%; No age limit

Implants and implant related services are not covered under the Base Plan.

Using in-network dental providers

As a Delta Dental PPO member, you may see any dentist you like. However, you will likely save the most money and receive the highest level of coverage when you visit a Delta Dental PPO Dentist.

When using an out-of-network dental provider, you will pay more because the provider has not agreed to charge you a negotiated rate.

Delta Dental will provide new members with an ID card.

Dental	Employee Cost Per Pay	Employee Cost Per Month	Full Invoiced Amount Per Month
Base Plan
Employee Only	$0.92	$2.00	$22.43
Family(e.g., ﬁllings)	$2.31	$5.00	$52.55
Buy-up Plan
Employee Only	$8.70	$18.86	$43.62
Family	$19.65	$42.58	$102.02