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2016 Retiree and Annuitant Dental Rates

​2016 Retiree and Annuitant Dental Plan Premiums

 State-Sponsored  Dental Plans

Delta Dental PPO plus Premier Basic Plan

This table shows the level of coverage for Delta Dental PPO plus Premier Basic Plan
Level of Coverage  State Share Retiree Share Total Premium 
Party Code 1$37.28$12.43$49.71
Party Code 2$65.09$21.70$86.79
Party Code 3$94.09$31.36$125.45

  

Delta Dental preferred provider option (PPO)

This table shows the level of coverage for Delta Dental preferred provider option (PPO)
Level of Coverage State Share Retiree Share Total Premium 
Party Code 1$34.07$11.36$45.43
Party Code 2$66.23$22.08$88.31
Party Code 3$99.66$33.22$132.88

 

 

Prepaid Dental Plan Premiums

This table shows the level of coverage for Prepaid Dental Plan Premiums
Level of CoverageDeltaCare USAPremier Access SafeGuard EnhancedWestern Dental
Party Code 1$17.99$16.83$16.92$15.16
Party Code 2$29.52$26.94$28.63$25.02
Party Code 3$40.83$37.73$35.27$35.49
 
  Updated: 8/17/2015
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