ACTION REQUIRED: If you wish to enroll in dental coverage, you must complete and submit an enrollment form to Human Resources within 30 days of becoming eligible for benefits.
Learn more about
Dental Insurance
Dental Plan Design
As a Delta Dental PPO Plus Premier subscriber, you have access to two of Delta Dental’s extensive national networks – Delta Dental PPO, with more than 278,000 participating dentist locations and Delta Dental Premier, the largest dental network in the country with more than 349,000 dentist locations.
In-Network
Calendar Year Deductible (Individual / Family)
$50 / $150
Calendar Year Maximum
$1,000
Preventive & Diagnostic Services
Covered 100% (deductible waived)
Basic Restorative Services
80% after deductible
Major Restorative Services
50% after deductible
Orthodontia
50% after deductible ($1,000 lifetime maximum)
*If your total yearly claims don’t exceed $500, then you can rollover $350. Your accumulated rollover cannot exceed $1,000.
Preventive
Procedures that dentists use to diagnose, monitor, and maintain a patient's oral health:
- Cleaning and oral exam
- Fluoride treatment
- Space maintainers
- Sealants
- X-rays
Basic
Treatments that are relatively straightforward and don’t involve a significant laboratory expense:
- Filling
- Tooth removal
- Root canal
- Anesthesia
Major
Procedures that are more complex and often involve a dental laboratory expense:
- Bridges and dentures
- Inlays, onlays, and veneers
- Crowns, bridges, and dentures (repair & maintenance)
Orthodontia
Specialist care and corrective action to align bite and/or straighten teeth:
- Appliances, including braces and retainers
- Only available to children, under age 19, on the plan
Contribution Rates
Weekly Deductions
Employee Only
$7.56
Employee & Spouse
$15.12
Employee & Child(ren)
$14.04
Employee & Family
$25.92
Contact the provider of these benefits by calling this phone number or visiting this website: (800) 872-0500, www.deltadentalma.com