Dental Plan
Your dental care benefits, administered through the Delta Dental Premier program, are designed to help pay for professional dental care for you and your family and covers dental services and supplies up to $1,000 per covered participant per calendar year and has a $1,500 lifetime maximum orthodontia benefit for eligible dependent children through age 18. A new calendar year benefit period begins each January 1.
Dental Deductible
No deductible is required for preventive care such as check ups and x-rays or for orthodontic care. For preventive care, the plan pays 100% of the covered charges.
There are, however, certain covered dental services that are subject to a combined annual deductible per calendar year of:
- $50 per individual (employee only)
- $100 per family (employee plus one and employee plus two or more).
When receiving services for basic restorative care, oral surgery for impacted and unimpacted teeth or major restorative care, the participant pays the first $50 per individual or $100 per family of the combined charges from these categories.
Any out-of-pocket costs that you incur, such as deductibles, employee paid percentage of coverage, and charges above the maximum plan allowance are the responsibility of the participant and are not applied toward the $1,000 maximum benefit provided under your dental plan.
After applicable deductible, dental coverage is provided as follows:
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Dental Service |
Coverage |
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Preventive Care
(check ups, x-rays) |
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100% (of covered services up to the maximum plan allowance) |
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Basic Restorative Care
(fillings, root canals, extractions, oral surgery) |
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80% (of covered services up to the maximum plan allowance)
subject to deductible |
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Major Restorative Care (bridges, dentures, crowns) |
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50% (of covered services up to the maximum plan allowance)
subject to deductible |
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Orthodontia Care |
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50% (of covered services up to the $1,500 orthodontia lifetime maximum) |
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Although you may visit the dentist of your choice, there are advantages to using a Delta Dental participating dentist:
- Delta Dental dentists file claims for you
- Your dental benefits are paid directly to Delta Dental
- Delta Dental dentists will only charge you the plan percentage of covered charges
- Delta Dental dentists will not charge you for any amount over Delta Dental's maximum plan allowance
To use your Delta Dental Premier benefits, simply present your Delta Dental ID card to the participating dental office when you or a covered family member receive dental care.
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