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Coverage and Costs for Certain Procedures: Prepaid Plans

 The following compares employee costs for certain types of procedures under each dental plan.  Please consult each dental plan's evidence of coverage for detailed information and plan limitations.  

The following compares employee costs for certain types of procedures under each dental plan.
Type of Plan  DeltaCare USA, Premier Access, SafeGuard, and Western Dental (Standard)
SafeGuard
(Enhanced)
Who is Covered? Represented Employees and Dependents Excluded Employees and Dependents

Diagnostic and Preventive Benefits (two cleanings annually)

No charge No charge*
Basic Benefits No charge No charge
Crowns $50 No charge
Bridges, Full and Partial Dentures ​$65 and up ​​No charge
Implants Premier Access and Western Dental only Not covered
Orthodontia

$1,000,  plus up to $250 for start-up costs

​​$1,000,  plus up to $250 for start-up costs
 

* SafeGuard (Enhanced) provides the availability for a third cleaning to the employee and all enrolled dependents.

  Updated: 8/16/2017
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