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

Need help? Use the HealthJoy app to find a provider.

 
Dental Plans
  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:

  1. You receive a 20% discount off the Specialist fee
  2. Plan pays according to the Reasonable and Customary fees
  3. 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:

  1. You receive a 20% discount off the Specialist fee
  2. Plan pays according to the Reasonable and Customary fees
  3. Member pays the difference between plan payment and discounted Specialist fee

Non-contracted Specialist payment:

Paid the same as non-contracted dentists

Dental Rates
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
COBRA Rates
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
Resources

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