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Dental Overview

The following table provides a general overview of the benefits available under the state-sponsored dental plans. Consult each plan’s brochure and evidence of coverage booklet for detailed information and plan limitations.

Overview of Dental Benefits
Plan Details Prepaid Indemnity Preferred Provider Option
Type of Plan Plan pays your chosen dentist a monthly fixed rate to provide services as needed. Fee-for-service plan. Plan provides reimbursement for services rendered. Plan provides maximum benefit when you visit an in-PPO network dentist.
Dental Providers Must select a dental provider affiliated with the prepaid plan. Any licensed dentist. However, out-of-pocket expenses may be lower when visiting a Delta Dental PPO dentist. Any licensed dentist, but maximum benefit when visiting a PPO network dentist. If an out-of-PPO network dentist is used, benefits are lower.
Orthodontic Providers Must use orthodontist affiliated with the prepaid plan. May visit any orthodontist. However, out-of-pocket expenses may be lower when visiting a Delta Dental PPO dentist. Must visit an in-PPO network orthodontist to receive maximum benefit.
Changing Providers You may change to another dentist affiliated with the plan, with prior approval. May change dentist at any time. May change dentist at any time.
Deductibles No deductible.

Basic: $50 per person, up to $150 annual maximum per family.

Enhanced: $25 per person, up to $100 annual maximum per family.

$25 per person, up to $100 annual maximum per family, for PPO network dentists.

$75 per person up to $200 annual maximum per family for non-PPO network dentists.

Co-payments Co-payments for certain covered procedures. May require payment at time of treatment.

You pay only the co-payment and any deductibles and charges above the annual maximum for covered services when visiting a Delta Dental dentist.

When visiting a non-Delta Dental dentist, you also pay the difference between the dentist’s submitted charges and Delta Dental’s approved fees.

You pay only the co-payment and any deductibles and charges above the annual maximum for covered services when visiting a Delta Dental dentist.

When visiting a non-Delta Dental dentist, you also pay the difference between the dentist’s submitted charges and Delta Dental’s approved fees.

Plan Payments Plan pays dentist monthly contract fee. Payments based on Delta Dentist contracted fees or the maximum plan allowance when non-Delta Dental dentists are used. Payments based on Delta Dentist contracted fees or the maximum plan allowance when non-Delta Dental dentists are used.
Maximum Benefits per Calendar Year

No maximum.

Basic: $2,000 for employee, $1,000 per dependent.

Enhanced: $2,000 for employee and each eligible dependent.

$2,000 for employee, $2,000 per eligible dependent when PPO network dentists are used.

$1,000 for employee, $1,000 per eligible dependent when non-PPO network dentists are used.

Implant Benefit Premier Access and Western Dental only. Not a covered benefit. Maximum lifetime benefits of $2,500 for each employee and dependent, if using a PPO plan provider.
  Updated: 9/29/2015
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