Dental
Dental coverage helps you maintain a healthy smile with preventive care, basic services, and major procedures. You can visit any licensed dentist, but you’ll save the most when you use an in-network provider who has agreed to discounted rates. Out-of-network dentists may charge more than the plan’s allowed amount, and you may be responsible for the difference. Most plans cover preventive services—such as exams, cleanings, and X-rays—at 100% when you stay in-network, making regular checkups an easy way to protect your oral health and avoid costly issues.
Delta Dental PPO Gold
Benefit Highlights
In-Network
Deductible (Per Individual)
$50/$150
Out-of-Pocket Max (Individual/Family)
$2,000 per member
Preventive Care
$0
Basic Services
20% after deductible
Major Procedures
40% after deductible
Orthodontia (Adults and Children)
50% after deductible up to a lifetime maximum benefit of $2,000 per individual
Out-of-Network
Deductible (Per Individual)
$50/$150
Out-of-Pocket Max (Individual/Family)
$2,000 per member
Preventive Care
$0
Basic Services
20% after deductible
Major Procedures
40% after deductible
Orthodontia (Adults and Children)
50% after deductible up to a lifetime maximum benefit of $2,000 per individual
Per Pay Period Plan Cost
Employee Only: $4.42
Employee and Spouse/DP: $8.84
Employee and Child(ren): $7.73
Employee and Family: $13.25
Delta Dental PPO Silver
Benefit Highlights
In-Network
Deductible (Individual/Family)
$XX
Annual Plan Max (Individual/Family)
$XX/$XX
Preventive Care
$0
Basic Services
XX%
Major Procedures
XX%
Orthodontia (Adults and Children)
XX% up to a lifetime maximum benefit of $XXX per individual; deductible waived
Out-of-Network
Deductible (Individual/Family)
$XX
Annual Plan Max (Individual/Family)
$XX/$XX
Preventive Care
$0
Basic Services
XX%
Major Procedures
XX%
Orthodontia (Adults and Children)
XX% up to a lifetime maximum benefit of $XXX per individual; deductible waived
Per Pay Period Plan Cost
Employee Only: $2.18
Employee and Spouse/DP: $4.37
Employee and Child(ren): $3.82
Employee and Family: $6.54