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 | $2,500 | $2,500 | $2,500 |
| 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 | $2,500 Lifetime | $2,500 Lifetime | $2,500 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.
2024 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
| Plan | Cost |
|---|---|
| Delta Dental PPO | $5.29 |
You & spouse/domestic partner
| Plan | Cost |
|---|---|
| Delta Dental PPO | $9.53 |
* You must generally pay for coverage of a domestic partner and a domestic partner's children on an after-tax basis, and the value of the Company subsidy, if any, must generally be included in your taxable income. This is called "imputed income." Contact your tax advisor for more information.
You & children
| Plan | Cost |
|---|---|
| Delta Dental PPO | $10.27 |
* You must generally pay for coverage of a domestic partner and a domestic partner's children on an after-tax basis, and the value of the Company subsidy, if any, must generally be included in your taxable income. This is called "imputed income." Contact your tax advisor for more information.
You, spouse/domestic partner & up to 2 children
| Plan | Cost |
|---|---|
| Delta Dental PPO | $16.94 |
* You must generally pay for coverage of a domestic partner and a domestic partner's children on an after-tax basis, and the value of the Company subsidy, if any, must generally be included in your taxable income. This is called "imputed income." Contact your tax advisor for more information.
You, spouse/domestic partner & 3 or more children
| Plan | Cost |
|---|---|
| Delta Dental PPO | $20.33 |
* You must generally pay for coverage of a domestic partner and a domestic partner's children on an after-tax basis, and the value of the Company subsidy, if any, must generally be included in your taxable income. This is called "imputed income." Contact your tax advisor for more information.
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.
Quip Virtual Dental Care
Download the Quip app for a virtual dentist screening from a Delta Dental PPO/Premier dentist. Just answer a few questions about your oral health and take photos of your mouth from your smartphone. You'll receive a personalized assessment report within 24 hours that will include care and treatment recommendations. Quip is recommended for routine dental exams — not for emergencies or major issues.
To get started, visit the Delta Dental website to register and create an account. Then, download the Quip app to your smartphone or tablet and log in to schedule your appointment.
Virtual Dental Consults
If you're having an urgent dental issue or if you need care after hours, schedule a Virtual Dental Consult. Virtual Consult connects you with a PPO/Premier Delta Dental dentist for a real-time video appointment. Virtual Consult makes urgent care, e-prescriptions (sent right to your pharmacy) and dental check-ins with Delta Dental dentists accessible from the comfort of your own home. Best of all, there's no cost to you for a Virtual Consult.
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.
Summary of Your Dental Benefits
Here's the Delta Dental Highlights Overview for your plan options and coverage.