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Dental Overview

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. 

Plan DetailsPrepaidIndemnityPreferred Provider Option

Type of Plan

​Plan pays your chosen dentist a monthly fixed rate to provide services as needed.

​Fee-for-service plan. Plan provides reimbursement for services rendered.

​Plan provides maximum benefit when you visit an in-PPO network dentist.

​Dental Providers

​Must select a dental provider affiliated with the prepaid plan.

​Any licensed dentist. However, out-of-pocket expenses may be lower when visiting a Delta Dental PPO dentist.

​Any licensed dentist, but maximum benefit when visiting a PPO network dentist. If an out-of-PPO network dentist is used, benefits are lower.

Othordontic Providers

​Must use orthodontist affiliated with the prepaid plan.

​May visit any orthodontist. However, out-of-pocket expenses may be lower when visiting a Delta Dental PPO dentist.

​Must visit an in-PPO network orthodontist to receive maximum benefit.

Changing Providers

​May change to another dentist affiliated with the plan, with prior approval.

​May change dentist at any time.

​May change dentist at any time.

Deductibles

​No deductible.

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.

Co-payments

​Co-payments for certain covered procedures. May require payment at time of treatment.

​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.

​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.

​Plan Payments

​Plan pays dentist’s monthly contract fee.

​Payments based on Delta Dentist contracted fees or the maximum plan allowance when non-Delta Dental dentists are used.

​Payments based on Delta Dentist contracted fees or the maximum plan allowance when non-Delta Dental dentists are used.

Maximum Benefits per Calendar Year

​No maximum.

​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.

​Implant Benefits

​Premier Access and Western Dental only.

​Not a covered benefit.

​Maximum lifetime benefits of $2,500 for each employee and dependent, if using a PPO plan provider.

  Updated: 9/24/2020
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