Delta Dental Plan
Member only dental coverage is provided for all members enrolled in medical coverage. If you choose to enroll your dependents in dental coverage the same dependents enrolled in dental coverage must be enrolled in medical coverage. Dependent dental coverage may not be dropped during the plan year unless dependent medical coverage is also dropped.
You have access to two Delta Dental provider networks.
The Delta Dental Premier Network is the broad network of providers that you may use. Delta Premier Dentists agree to accept the plan allowance as payment in full. You will be responsible only for paying the specific coinsurance and deductibles for covered services in addition to any services not covered.
Delta Dental also offers the Delta Dental PPO network. The PPO network providers have agreed to a reduced fee for providing dental services. As a result, you generally pay a lower percentage of the total bill than you would when using a Premier (or Non Network) Provider. The PPO network for our group includes all PPO providers in the national DeltaUSA PPO network. Participants have the option to use the PPO providers whenever desired.
Preventive Care Services are always covered at 100 percent of the allowed amount. Ninety days after a preventive office visit or cleaning, the member is eligible for the Enhanced benefit. If the member has had at least one routine prophylaxis (cleaning) and/or preventive oral exam in the preceding 12 months, basic restorative services are subject to a coinsurance of 20% when provided by a PPO provider and 40% coinsurance when provided by a Premier or Non Network provider. Major restorative services are covered at the 50% coinsurance rate for all providers.
The Basic benefit applies when the member has not had at least one routine prophylaxis (cleaning) and/or preventive oral exam in the prior 12 months. The member is responsible for paying 50% coinsurance for all basic and major restorative services, regardless of provider. For those at the Basic benefit level, you must wait 90 days from your cleaning or exam to qualify for the Enhanced benefit level.
New employees will have a one year grace period at the Enhanced level to get their annual exam and cleaning.
Diagnostic and preventative services are covered at 100% with no deductible. Covered services include:
• Prophylaxis/cleanings – twice per plan year.
• Oral examinations – twice per plan year.
• Bitewing x-rays –
- adults - once per plan year
- children under 18 - twice per plan year
• Full mouth x-rays – once each five (5) years.
• Limited coverage for children only:
- Space maintainers
- Topical fluoride
• Ancillary – emergency relief of pain.
A deductible of $50 per person with a maximum annual family deductible of $150 applies to all basic and major restorative care. This includes:
• Regular restorative dentistry - fillings
• Oral surgery
• Endodontics – root canals
• Periodontics – treatment of gum and bone disease
• Additional diagnostic X-rays
• Special restorative dentistry – crowns
• Prosthodontics – bridges and dentures
• TMJ Treatment – requires prior authorization
A $1,000 per person per lifetime benefit applies to orthodontic benefits, and there is an annual benefit maximum of $1,700 per person per year for all dental services except orthodontics. Implants have a limited coverage of up to a maximum of $1,250 per year.
See the Benefit Description for limitations or exclusions of the plan.