DENTAL INSURANCE DENTAL PLAN INFORMATION
65%+ FTE FACULTY 75%+ FTE STAFF
ELIGIBILITY
PLAN INFORMATION
COMPREHENSIVE W/ ORTHO $50 PER PERSON $150 FAMILY DOES NOT APPLY TO DIAGNOSTIC, PREVENTIVE, OR ORTHO SERVICES $2,000 PER PERSON, EXCLUDING ORTHODONTIC SERVICES
BASIC
COMPREHENSIVE
$50 PER PERSON $150 FAMILY DOES NOT APPLY TO DIAGNOSTIC OR PREVENTIVE
$50 PER PERSON $150 PER FAMILY
ANNUAL DEDUCTIBLE
$1500 PER PERSON, EXCLUDING ORTHODONTIC SERVICES
$500 PER PERSON
ANNUAL MAXIMUM BENEFIT
80% AFTER DEDUCTIBLE
100% NO DEDUCTIBLE
100% NO DEDUCTIBLE
DIAGNOSTIC & PREVENTIVE CARE
BASIC SERVICES 60% OF PERIODONTIC SERVICES 80% OTHER SERVICES
80% AFTER DEDUCTIBLE
80% AFTER DEDUCTIBLE
80% ON TMD TREATMENT 60% OTHER SERVICES
80% AFTER DEDUCTIBLE
80% AFTER DEDUCTIBLE
MAJOR SERVICES
60%* LIFETIME MAX $2,000 PER ELIGIBLE DEPENDENT UNDER AGE 19
NOT COVERED
ORTHODONTIC SERVICES
NOT COVERED
EMPLOYEE CONTRIBUTION
RATES VARY BASED ON COVERAGE SELECTION https://mailuc.sharepoint.com/sites/HR-Benefits/SitePages/Delta-Dental---UC-Dental-Carrier- Effective-January-1,-2021.aspx (CHOOSE 2021 Non-AAUP)
PLAN ADMINISTRATOR DELTA DENTAL The percentages are applied to Delta Dental's allowance for each service and it may vary due to the dentist's network participation.
Additional Insurance 2
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