Overall good health includes taking care of your oral health. Delta Dental, the provider and administrator for the Dental Plan, gives you expanded network coverage and great service.
Overall good health includes taking care of your oral health. Delta Dental, the provider and administrator for the Dental Plan, gives you expanded network coverage and great service.
| Coverage Level | Full Time* | Part-Time* |
| Teammate Only | $9 | $12 |
| Teammate + Spouse | $25 | $31 |
| Teammate + Children | $30 | $39 |
| Teammates, Spouse & Children | $43 | $55 |
Deducted 26 times per calendar year (Note: Monthly teammates multiply premium by 26 and divide by 12.)
*Full-time premiums apply to teammates with standard hours of 30 or more per week (60 or more per pay period.)
**Part-time premiums apply to teammates with standard hours of 20-29 per week (40-59 per pay period.)
| Plan Feature | Benefits |
| Calendar Year Maximum (Class I, II, III Expenses) | $2,000 / $1,700* |
| Calendar Year Deductible | Individual $50 per person Aggregate Family Maximum $150 per family |
| Preventive & Diagnostic Care/Certain Restrictions Apply
Oral Exams, Cleanings, Full mouth X-rays, Bitewing X-rays, Panoramic X-rays, Fluoride application, Sealants, Space maintainers, Emergency care to relieve pain |
100%, no deductible, does not apply to coverage maximum Reasonable and customary limits apply to out-of-network |
| Basic Restorative Care
Fillings, Cleanings, Root canal therapy, Osseous surgery, Periodontal scaling and root planning, Denture adjustments and repairs, Extractions, Anesthetics, Oral surgery |
80%, after deductible Reasonable and customary limits apply to out-of-network |
| Major Restorative Care
Crowns, dentures, bridges, implants |
50%, after deductible Reasonable and customary limits apply to out-of-network |
| Orthodontia (Teammate & Dependents) | 50%, after deductible
$1,500 per person - lifetime maximum Reasonable and customary limits apply to out-of-network |
| Pretreatment Review | Available on a voluntary basis when extensive dental work in excess of $200 is proposed |
*Once calendar year maximum is met, any additional dental services are paid out-of-pocket for the remainder of the plan year.
To access and request an ID card for your Dental Benefits, follow these steps:
Contact Delta Dental with questions about your Dental Benefits at 800-662-8856.
