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2015 Retiree and Annuitant Dental Rates

2015 Retiree and Annuitant Dental Plan Premiums

 

Delta Dental PPO plus Premier

The amount that will be deducted from your retirement check each month for Delta Dental PPO plus Premier will be:
 

 

  • Party Code 1 (yourself only) $12.21
  • Party Code 2 (yourself plus one dependent) $21.32
  • Party Code 3 (yourself plus two or more dependents) $30.82
 

Delta Dental Preferred Provider Option (PPO)

 The amount that will be deducted from your retirement check each month for the PPO will be:
 
 
  • Party Code 1 (yourself only) $11.16
  • Party Code 2 (yourself plus one dependent) $21.69
  • Party Code 3 (yourself plus two or more dependents) $32.64

 

 

Prepaid Dental Plans

 

The state will pay 100 percent of the premium for prepaid plans.
 
  Updated: 9/17/2015
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