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 (Individual/Family)
$50/$150
Plan Maximum
$2,000
Preventive Care
$0 (coverage limited to 2 times per calendar year)
Basic Services
20% after deductible
Major Procedures
40% after deductible
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,000 per individual; deductible waived
Out-of-Network
Deductible (Individual/Family)
$50/$150
Plan Maximum
$2,000
Preventive Care
$0 (coverage limited to 2 times per calendar year)
Basic Services
20% after deductible
Major Procedures
40% after deductible
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,000 per individual; deductible waived
Per Pay Period Plan Cost
Employee Only: $5.00
Employee and Spouse/DP: $15.00
Employee and Child(ren): $15.00
Employee and Family: $30.00