Employee Only

Employee + Family

Delta Dental

           $3.91

           $11.73

Services

In-Network

Out-of- Network

Diagnostic & Preventative Services
Cleanings & Routine exams 2x/ year

Plan Pays 100%
No deductible
You pay: 0%

Plan Pays 100%
No deductible
You pay: 0%

Basic Services
Fillings, root canals, extractions, dental surgery-repairs

Plan Pays 80%
Deductible applies
You Pay: 20%

Plan Pays 55%
Deductible applies
You Pay: 45%

Major Services
Crowns, bridges, dentures, implants

Plan Pays 60%
Deductible applies
You Pay 40%

Plan Pays 35%
Deductible applies
You Pay: 65%

Orthodontic Services

Children up to 18th birthday
Up to $2000 lifetime max – you pay 25%
Adults 18 and older
Up to $1750 lifetime max – you pay 40%

Deductible

$50 per enrolled person
$150 aggregate per family

Calendar Year Maximum

Plan pays up to $1750 per enrolled person