2021 Retiree Dental Plan Premiums

The premiums shown premiums shown below are effective January 1, 2021.

State-Sponsored Dental Plans

Dental Plans Prepaid Dental Plans
Level of Coverage	DeltaCare USA	*MetLife Enhanced**	Premier Access	Western Dental
Party Code 1	$19.44	$16.06	$15.48	$15.77
Party Code 2	$31.90	$27.18	$25.08	$26.02
Party Code 3	$44.13	$33.48	$35.12	$36.91

*Benefits provided by SafeGuard Health Plans, Inc., a MetLife company

Delta Dental PPO plus Premier Basic Plan
Level of Coverage	State Share	Retiree Share	Total Premium
Party Code 1	$38.12	$12.71	$50.83
Party Code 2	$66.56	$22.19	$88.75
Party Code 3	$96.21	$32.07	$128.28

Delta Dental Preferred Provider Plan (PPO)
Level of Coverage	State Share	Retiree Share	Total Premium
Party Code 1	$34.84	$11.61	$46.45
Party Code 2	$67.73	$22.58	$90.31
Party Code 3	$101.91	$33.97	$135.88