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2017 Dental Plan Premiums

​​For employees in CoBen, the state share and employee share does not apply.  Therefore, the total dental premium will be deducted from your monthly CoBen allowance.  The following tables show premiums effective January 1, 2017.

​State-Sponsored Dental Plans

Prepaid Dental Plan Premiums

Level of Coverage​DeltaCare USA​Premier Access​SafeGuard StandardSafeGuard Enhanced​​Western Dental

​Party Code 1

​$18.87

​$15.80

​$16.58

$16.92​

​$15.16

​Party Code 2

​$30.97

​$25.59

$26.86

$​28.63

​$25.02

​Party Code 3

​$42.84

​$35.84

​$37.62

​$35.27

​$35.49

 

Delta Dental PPO plus Premier Basic Plan for Represented Employees

​Level of Coverage​State Share​Employee Share​Total Premium

​Party Code 1

​$38.72

​$12.91

​$51.63

​Party Code 2

​$67.61

​$22.53

​$90.14

​Party Code 3

​$97.72

​$32.57

​$130.29

 

 

​Delta Dental PPO plus Premier Enhanced Plan for Excluded Employees

​Level of Coverage​Total Premium

​Party Code 1

​$53.70

​Party Code 2

​$105.69

​Party Code 3

​$148.47

 

Delta Dental Preferred Provider Option (PPO) for Excluded and Represented Employees

​Level of Coverage​State Share​Employee Share​Total Premium

​Party Code 1

​$35.39

​$11.79

​$47.18

​Party Code 2

​$68.79

​$22.93

​$91.72

​Party Code 3

​$103.51

​$34.50

​$138.01

 

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