Jefferson Center - 2025 Open Enrollment Benefit Guide

Dental Insurance

Jefferson Center offers PPO dental insurance through Delta Dental of Colorado . This dental plan includes in- and out-of- network benefits, which means you can choose any dentist that you would like. However, you will pay less out of your pocket when you choose a Delta Dental of Colorado PPO network dentist. Locate a Delta Dental of

Do I need to see a dentist?

Colorado network dentist at www.deltadentalco.com.

A visit to the dentist is about more than just a teeth cleaning. By looking in your mouth, your dentist can tell a lot about your overall health. In fact, he or she may be able to identify early signs of disease, such as diabetes, heart disease, kidney disease, and even some forms of cancer, before you even notice symptoms.

The table below summarizes the key features of the dental plans. Please refer to the official plan documents for additional information on coverage and exclusions.

PPO*

Premier**

Non-Network***

$50 / $150

Deductible (individual/family)

$1,500 per enrolled member

Annual Benefit Maximum

Plan pays 100%; deductible waived

Member pays 20%; deductible waived

Member pays 20% + any balance billed charges not covered; deductible waived Member pays 50% + any balance billed charges not covered; after deductible Member pays 75% + any balance billed charges not covered; after deductible

Diagnostic / Preventive Services

Member pays 20% after deductible

Member pays 50% after deductible

Basic Services

Member pays 50% after deductible

Member pays 75% after deductible

Major Services

Plan pays 50% up to lifetime maximum benefit of $1,000 per enrolled eligible dependent

Orthodontia / Braces (up to age 19)

PREVENTION FIRST INCLUDED – Diagnostic and preventive care services do not apply toward the calendar year maximum.

*PPO contracted providers extend the deepest discount for services resulting in the strongest benefit at the least out-of-pocket costs to DDCO plan members. The PPO percentage of benefits is based on the PPO Schedule of Allowance.

**Premier providers percentage of benefits is limited to the Premier Maximum Plan Allowance and will have higher out-of-pocket costs for plan members accessing care from a Premier provider.

***Non-participating (out-of-network) providers are not bound by contracted fees for services; therefore, plan members are responsible for the difference between the non-participating maximum plan allowance and the full fee charged by the dentist.

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