Dental

Overview:

The plan pays 100% of preventive care services like cleanings, exams and most X-rays with no deductible when using an in-network provider. For basic services, major services, and orthodontia, the plan pays 50-80% of costs after meeting your annual deductible depending on the type of service needed and if you’re using in-network or out-of-network providers.

When it comes to dental providers, you have two choices: in-network or out-of-network. Delta Dental has the largest network of dentists nationwide, which makes it easy to find an in-network provider.

Choosing an in-network provider has some major advantages:

You pay less.
There is no waiting for reimbursement.
There is less paperwork.

You can find an in-network provider by using Delta Dental‘s dentist finder.

Delta Dental network offers a nationwide network. Although you may choose any dentist you wish, your out-of-pocket costs will be less if you see a participating network dentist. When choosing an out of network dentist, you and your dentist will be required to submit a claim form to Delta Dental.

Keep in mind that you can use your HSA or FSA (if applicable) to pay for your out-of-pocket in-network or out-of-network costs.

Plan Features:

	In-Network	Out-of-Network
Annual Deductible (Individual/Family)	$50/$150	$100/$300
Preventive Care •Exams •Cleanings •Most X-rays	Plan pays 100% (annual deductible does not apply)	Plan pays 100%* (annual deductible does not apply)
Basic Services •Fillings •Extractions •Oral surgery	Plan pays 80% (after annual deductible)	Plan pays 50%* (after annual deductible)
Major Services •Dentures •Crowns •Bridges	Plan pays 50% (after annual deductible)	Plan pays 20%* (after annual deductible)
Orthodontia Services	Plan pays 50% (after annual deductible)	Plan pays 20%* (after annual deductible)
Annual Maximum Benefit	$1,700 per covered person
Lifetime Orthodontia Maximum Benefit	$2,000 per eligible covered person

*While in-network benefits are based on negotiated fees, out-of-network benefits are based on maximum approved fees. You are responsible for any costs above maximum approved fees.