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. The plan covers preventive services—such as exams, cleanings, and X-rays—making regular checkups an easy way to protect your oral health and avoid costly issues.
Delta Dental PPO
Benefit Highlights
Delta Dental PPO Dentists
Delta Dental Premier Dentists
Non-Delta Dental Dentists**
Deductible Individual/Family
$50/$150
Annual Plan Maximum
$1,500
Preventive Care
$0
Basic Services
20%*
Major Procedures
20%*
Orthodontia (Children up to age 26)
50% up to a lifetime maximum benefit of $1,000 per individual; deductible waived
Deductible Individual/Family
$50/$150
Annual Plan Maximum
$1,500
Preventive Care
$0
Basic Services
20%*
Major Procedures
20%*
Orthodontia (Children up to age 26)
50% up to a lifetime maximum benefit of $1,000 per individual, deductible waived
Deductible Individual/Family
$50/$150
Annual Plan Maximum
$1,500
Preventive Care
$0
Basic Services
20%*
Major Procedures
20%*
Orthodontia (Children up to age 26)
50% up to a lifetime maximum benefit of $1,000 per individual, deductible waived
** Out-of-network providers will be paid at usual, customary and reasonable (UCR) limits. You will be responsible for any charges in excess of UCR.
Plan Cost
Monthly Cost
Team Member Only: $25.00
Team Member and 1 Dependent: $53.00
Team Member and Family: $75.00
Bi-Weekly Cost
Team Member Only: $12.50
Team Member and 1 Dependent: $26.50
Team Member and Family: $37.50