Dental - 2024 | ARUP Laboratories

Archive: Dental 2023

Delta Dental

https://www1.deltadentalins.com
800-521-2651
$2,000 or $2,500 benefit coverage
Two preventive basic cleanings each year at no cost
Basic and major dental services coverage
Providers nationwide on the Delta Dental PPO and Premier networks
Orthodontia benefits on the Dental Plus plan

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	Dental (2000) Summary Plan Description		Dental Plus (2500) Summary Plan Description
Services	Contracted Dentist	Non-Contracted Dentist	Contracted Dentist	Non-Contracted Dentist
Preventive
Routine exams, cleanings (2 per year), topical fluoride, x-rays, space maintainers, sealants	100%	100% of R&C	100%	100% of R&C
Basic
Composite fillings, extractions, oral surgery, endodontics, periodontics (No Waiting Period)	80%	80% of R&C	80%	80% of R&C
Major
Crowns, bridges, dentures, surgical implants (No Waiting Period)	50%	50% of R&C	50%	50% of R&C
Orthodontics
Lifetime Maximum	No Benefit	No Benefit	$2000	$2000
Maximum Benefit (Applies to Basic and Major Services Per Benefit Period)
Benefit Period is Per Calendar Year	$2,000		$2,500
Deductible (Per Benefit Period)
Per Person: Family Maximum:	$50.00 $150.00	$50.00 $150.00	$50.00 $150.00	$50.00 $150.00
Specialists Endodontists, Oral Surgeons, Pediatric, Periodontists, Prosthodontists
Contracted Specialist payment:	You receive a 20% discount off the Specialist fee Plan pays according to the Reasonable and Customary fees Member pays the difference between plan payment and discounted Specialist fee
Non-contracted Specialist payment:	Paid the same as non-contracted dentists
Contracted Specialist payment:	You receive a 20% discount off the Specialist fee Plan pays according to the Reasonable and Customary fees Member pays the difference between plan payment and discounted Specialist fee
Non-contracted Specialist payment:	Paid the same as non-contracted dentists

2024	Full Time	Part Time
	Monthly	Monthly
Dental (2000)
Single	$10	$20
Two party	$22	$35
Family	$29	$45
Dental Plus (2500)
Single	$28	$40
Two party	$64	$102
Family	$86	$127

2024
Dental 2000 (Cost per month)
Employee	$36
Employee + 1 Child	$81
Employee + Spouse	$81
Employee + Children	$107
Employee + Family	$107
Dental Plus 2500 (Cost per month)
Employee	$48
Employee + 1 Child	$109
Employee + Spouse	$109
Employee + Children	$147
Employee + Family	$147

If you have any difficulty reading the documents linked below, you may be able to get a copy in your preferred language. Please call: 1-866-530-9675

Delta Dental