DENTAL
You have two dental plans to choose from, both administered by Delta Dental. You’ll save the most money and time — you won’t have to file claims yourself – if you see a Delta Dental provider.
DENTAL BENEFITS
STANDARD PLAN
MAXIMUM PLAN
DIAGNOSTIC AND PREVENTIVE SERVICES Oral exams and routine cleaning (two per year), x-rays (one bitewing per year, one full mouth every three years), and fluoride treatments (two per year, to age 19) BASIC SERVICES Oral surgery, anesthesia, fillings, extractions, endodontia and periodontia MAJOR SERVICES AND ORTHODONTIA* Crowns, cast restorations, fixed bridgework, dentures and orthodontia (to age 19)
Plan pays 100%*
Plan pays 100%*
Plan pays 50%
Plan pays 80%
Plan pays 50%
Plan pays 50%
ANNUAL BENEFIT MAXIMUM
$1,500
$2,000
ORTHODONTIA LIFETIME MAXIMUM
$1,500
$2,000
YOUR WEEKLY PAYROLL DEDUCTION
STANDARD PLAN
MAXIMUM PLAN
ASSOCIATE ONLY
$3.55
$5.65
ASSOCIATE + SPOUSE ASSOCIATE + CHILD(REN)
$7.90
$12.55
$8.70
$13.60
FAMILY
$11.95
$16.65
*New enrollees will be subject to a 12-month waiting period for major services and orthodontia.
NEW FOR 2024 Effective 2024, members who complete at least one preventive service during each plan year will have their annual maximum increased by an additional $200. But keep up the good work — you can have an additional $200 added for up to 5 years to an additional $1,000 in annual maximum benefit. If you don’t complete preventive services in a given year, the annual max reverts to the original benefit and the rollover is lost. ENHANCED BENEFIT FOR SPECIAL NEEDS DEPENDENTS With this enhanced benefit, your dependents with special needs have access to: • Additional visits to the dentist’s office and/or consultations that can be helpful prior to the first treatment to help patients learn what to expect and what is needed for a successful dental appointment. • Up to four total dental cleanings in a benefit year. • The use of silver diamine fluoride that can be applied to cavities for patients who can’t tolerate the use of dental instruments. • Treatment delivery modifications necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, severe anxiety or other barriers to treatment.
See Summary Plan Description (SPD) for further details.
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