Dental Rates

Dental Plans

2027	Dental (2000)		Dental Plus (2500)
Services	Contracted Dentist	Noncontracted Dentist	Contracted Dentist	Noncontracted Dentist
Preventive
Routine exams, cleanings (two per year), topical fluoride, X-rays, space maintainers, sealants	100%	100% of reasonable and customary (R&C) fees	100%	100% of R&C
Basic
Composite fillings, extractions, oral surgery, endodontics, periodontics (no waiting period)	80%	90% of R&C	80%	90% 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	$2,000	$2,000
Maximum Benefit (Benefit period is per calendar year)
Applies to basic and major services per benefit period	$2,000		$2,500
Deductible (Per benefit period)
Per person: Family maximum:	$50 $150	$50 $150	$50 $150	$50 $150
Specialists Endodontists, oral surgeons, pediatric, periodontists, prosthodontists
Contracted specialist payment	You receive a 20% discount off the specialist fee Plan pays according to the R&C fees Member pays the difference between plan payment and discounted specialist fee
Noncontracted specialist payment	Paid the same as noncontracted dentists

COBRA Rates

$2,000 or $2,500 benefit coverage
Two preventive basic cleanings covered each year at no cost
Coverage for basic and major dental services
Providers available nationwide on the Delta Dental PPO and Premier networks
Orthodontia benefits on the Dental Plus plan
- The Dental Plus plan includes orthodontia coverage for all ages. This is a 50% benefit to a lifetime maximum of $2,000.
- In order to receive the full $2,000 benefit, you will need to be enrolled in this plan at the time of banding and at the end of treatment.
  - $1,000 is paid at the beginning of treatment.
  - $1,000 is paid 12 months later.
No physical ID cards mailed—access your information on the HealthJoy app, the Delta Dental app, or Delta Dental website
Summary Plan Description

ID Card Information
How do I access my ID card?

Resources
Dental Plan Description
Dental Plus Plan Description
Employee Benefit Booklet

Did you have services performed by an out-of-network provider?

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.

Dental