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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.  

Type of Plan  DeltaCare USA, Premier Access, SafeGuard, and Western Dental (Standard)
Who is Covered?Represented Employees and DependentsExcluded Employees and Dependents
Diagnostic and Preventive Benefits (two cleanings annually)No chargeNo charge*
Basic BenefitsNo chargeNo charge
Crowns$50No charge
Orthodontia​$1,000,  plus up to $250 for start-up costs​​$1,000,  plus up to $250 for start-up costs
Bridges, Full & Partial Dentures$65 and upNo charge
ImplantsPremier Access and Western Dental onlyNot covered

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

  Updated: 7/22/2016
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