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.
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.
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.
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.