The following chart provides a comparison of costs for certain procedures covered by the state-sponsored dental plans. Please consult each dental plan's Evidence of Coverage for detailed information and plan limitations.
Comparison of Dental Plan Benefits
Type of Plan | Delta Dental PPO plus Premier | Delta Dental PPO plus Premier | PPO/using Participating Provider1 | PPO/using Non-Participating Provider |
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Who is Covered | Retirees | Dependents of Retirees | Retirees and Dependents | Retirees and Dependents |
Diagnostic and Preventive Benefits (two cleanings annually) | No charge2 | No charge2 | No charge2,3 | 20%3 |
Basic Benefits | 10% | 20% | 10% | 20% |
Crowns | 20% | 50% | 20% | 50% |
Bridges, Full & Partial Dentures | 50% | 50% | 40% | 50% |
Implant Benefit | N/A | N/A | Will pay 50% up to a lifetime maximum of $2,500 | Will pay 50% up to a lifetime maximum of $2,500 |
Orthodontia | Will pay up to 50% of approved fee for orthodontia, with a lifetime maximum for this benefit of $1,000 for retiree | Will pay up to 50% of approved fee for orthodontia, with a lifetime maximum for this benefit of $1,000 for dependents | Will pay up to 50% of approved fee, with a lifetime maximum of $1,000 for each adult and $1,500 for dependent children | Will pay up to 50% of approved fee, with a lifetime maximum of $1,000 for each adult and $1,000 for dependent children |
Annual Deductible | $50 | $50 per person | $25 per person | $75 per person |
Maximum Deductible | $50 | $150 per family | $100 per family | $200 per family |
Annual Maximum | $2,000 | $1,000 | $2,000 | $1,000 |
1. Diagnostic and Preventive Benefits are exempt from the deductible.
2. The level of benefits and covered services reflected in the chart are based on services provided by a PPO Plan dentist; for services provided by a non-PPO plan dentist, the level of benefits is lower.
3. The PPO includes a third cleaning for high-risk patients.