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2021 Dental Plan Premiums

For employees in CoBen, the state share and employee share do not apply.  Therefore, the total dental premium will be deducted from your monthly CoBen allowance.  The following tables show premiums effective January 1, 2021.

​State-Sponsored Dental Plans

Prepaid Dental Plan Premiums

Prepaid Dental Plan Premiums
Level of Coverage​ DeltaCare USA​ MetLife* Standard​ MetLife* Enhanced Premier Access​ ​Western Dental

​Party Code 1

​$19.44

​$15.74

$16.06​

​$15.48

​$15.77

​Party Code 2

​$31.90

​$25.50

$​27.18

​$25.08

​$26.02

​Party Code 3

​$44.13

​$35.71

​$33.48

​​$35.12

​$36.91

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

​Delta Dental PPO plus Premier Basic Plan for Represented Employees

Prepaid Dental Plan Premiums
​Level of Coverage ​State Share ​Employee 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 PPO plus Premier Enhanced Plan for Excluded Employees

Delta Dental PPO plus Premier Enhanced Plan for Excluded Employees
​Level of Coverage ​Total Premium

​Party Code 1

​$52.87

​Party Code 2

​$104.06

​Party Code 3

​$146.18

 

​Delta Dental Preferred Provider Option (PPO) for Excluded and Represented Employees

​Delta Dental Preferred Provider Option (PPO) for Excluded and Represented Employees
​Level of Coverage ​State Share ​Employee 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

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