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.
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Delta Dental PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Annual Plan Max
$3,500 per individual
Preventive Care
$0
Basic Services
10%
Major Procedures
10%
Orthodontia (Adults and Children)
25% up to a lifetime maximum benefit of $2,500 per individual
Out-of-Network
Deductible
$25 per individual
Annual Plan Max
$3,500 per individual
Preventive Care
$0
Basic Services
20% after deductible
Major Procedures
20% after deductible
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,500 per individual
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
DeltaCare USA Dental HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Annual Plan Max
Unlimited
Preventive Care
$5-$45 copay (varies by services; see contract for fee schedule)
Basic Services
$5-$90 copay (varies by services; see contract for fee schedule)
Major Procedures
$5-$195 copay (varies by services; see contract for fee schedule)
Orthodontia (Adults and Children)
$1,700-$1,900 copay (varies by services; see contract for fee schedule)
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX