Dental
Dental coverage helps you maintain a healthy smile with preventive care, basic services, and major procedures. You can visit any licensed dentist, but you’ll save the most when you use an in-network provider who has agreed to discounted rates. Out-of-network dentists may charge more than the plan’s allowed amount, and you may be responsible for the difference. Most plans cover preventive services—such as exams, cleanings, and X-rays—at 100% when you stay in-network, making regular checkups an easy way to protect your oral health and avoid costly issues.
Delta Dental PPO
Benefit Highlights
In-Network
Deductible (Per Individual)
$50/$150
Plan Maximum
$2,000
Preventive Care
$0
Basic Services
20%
Major Procedures
50%
Orthodontia (Adults and Children)
Not covered
Out-of-Network
Deductible (Per Individual)
$50/$150
Plan Maximum
$2,000
Preventive Care
$0
Basic Services
20%
Major Procedures
50%
Orthodontia (Adults and Children)
Not covered
Monthly Plan Cost
Tier A ( up to $49/hr)
Employee Only: $19
Employee + Spouse/DP: $53
Employee + Child(ren): $44
Employee + Family: $67
Tier B ($49/hr to $98/hr)
Employee Only: $20
Employee + Spouse/DP: $57
Employee + Child(ren): $47
Employee + Family: $69
Tier C ($98/hr and up)
Employee Only: $27
Employee + Spouse/DP: $74
Employee + Child(ren): $63
Employee + Family: $89
Partners
Employee Only: $58.15
Employee + Spouse/DP: $127.87
Employee + Child(ren): $106.13
Employee + Family: $146.98
DeltaCare Dental HMO
Benefit Highlights
In-Network
Preventive Care
$0
Basic Services
Fee schedule
Major Procedures
Fee schedule
Orthodontia (Adults and Children)
Copayments for each phase of orthodontic treatment is listed in fee schedule.
Comprehensive treatment (first 24 months):
$1,700 copay (child up to 19)
$1,900 copay (adult)
Out-of-Network
Preventive Care
$0
Basic Services
Fee schedule
Major Procedures
Fee schedule
Orthodontia (Adults and Children)
Copayments for each phase of orthodontic treatment is listed in fee schedule.
Comprehensive treatment (first 24 months):
$1,700 copay (child up to 19)
$1,900 copay (adult)
Monthly Plan Cost
Tier A ( up to $49/hr)
Employee Only: $4
Employee + Spouse/DP: $12
Employee + Child(ren): $10
Employee + Family: $22
Tier B ($49/hr to $98/hr)
Employee Only: $6
Employee + Spouse/DP: $15
Employee + Child(ren): $13
Employee + Family: $27
Tier C ($98/hr and up)
Employee Only: $8
Employee + Spouse/DP: $18
Employee + Child(ren): $16
Employee + Family: $30
Partners
Employee Only: $15.45
Employee + Spouse/DP: $27.68
Employee + Child(ren): $32.24
Employee + Family: $47.37