Dental

Your dental coverage is provided through the Delta Dental Preferred Option (PPO) Plan. Our Plan allows you to see any licensed dentist, but the Plan pays increased benefits when you use a Delta Dental PPO dentist.

Benefits and Covered Services
  Delta Dental PPO dentists* Delta Dental Premier dentists* Non-Delta Dental PPO dentists*
Deductible None $50 per person / $100 family each calendar year $50 per person / $100 family each calendar year
Benefit Maximum $1,500 $1,500 $1,500
Diagnostic and preventive services: Exams, cleanings, X-rays, sealants 100% 100% 100%
Basic services: Fillings, simple tooth extractions, night guards 90% 80% 80%
Major services: Crowns, inlays, onlays and cast restorations, bridges and dentures, implants 60% 50% 50%
Orthodontic Benefits 50% 50% 50%
Orthodontic Maximum $2,000 Lifetime $2,000 Lifetime $2,000 Lifetime

* Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists, and program allowance for non-Delta Dental dentists.

For additional details about the dental plan including what is excluded, see the documents provided below.

2019 Employee Cost Per Pay Period

You may elect to cover yourself only or yourself and any eligible dependents. Below is the cost per paycheck. Any premiums paid by you—other than for domestic partner coverage—are on a pretax basis.

Employee only
You & spouse/domestic partner
You & children
You, spouse/domestic partner & up to 2 children
You, spouse/domestic partner & 3 or more children
Delta Dental PPO vs. Non-PPO Dentists

If you see a Delta Dental PPO Dentist:

  • PPO dentists agree to accept a reduced fee for PPO patients. You will usually pay the lowest amount for services when you visit a Delta Dental PPO dentist.
  • You are charged only the patient’s share at the time of treatment. Delta Dental pays the Plan’s portion directly to the dentist.
  • PPO dentists will complete claim forms and submit them for you at no charge.

If you see a non-PPO Delta Dental dentist (includes Delta Dental Premier Dentists and non-Delta Dental Dentists):

  • You are responsible for the difference between the allowed amount the Plan pays and the amount the dentist bills. You will usually have the highest out-of-pocket costs when you visit a non-Delta Dental PPO dentist. Premier dentists may not bill above Delta Dental’s approved amount, so your out-of-pocket costs may be lower than with non-Delta Dental dentists’ charges.
  • Non-Delta Dental dentists may require you to pay the entire amount of the bill in advance and wait for reimbursement. Premier dentists charge you only the patient’s share at the time of treatment.
  • You may have to complete and submit your own claim forms. Premier dentists will complete the claim forms and submit them for you at no charge.
Online Information

The Delta Dental website allows you to manage your dental benefits online. You may register to view your policy information, check the status of a claim, or gain access to your enrollment information and print out an ID card.

Legal Notices

For detailed summaries and legal disclosures, visit the Legal Notices page.