Provider: Delta Dental
Toll Free: 1-800-234-3375
Visit www.deltadentalks.com to:
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Check your eligibility and plan information |
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Print yourself an ID card |
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Check claim status |
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Locate a participating DeltaPremier dentist anywhere in the United States |
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Estimate your out-of-pocket dental care costs with the Flexible Spending Account Estimator |
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Learn about oral health and wellness |
Quick Facts
Benefit |
DIAGNOSTIC & PREVENTIVE (Not subject to deductible or annual) |
100% |
Diagnostic (exams and x-rays) |
100% |
Preventive (cleanings, fluoride, space maintainers and sealants) |
|
BASIC (Subject to deductible)
|
50% |
Ancillary (one emergency exam per year for relief of pain) |
50% |
Oral Surgery (extractions and other oral surgery including anesthesia, pre and post-operative care) |
50% |
Regular Restorative (amalgram andcomposite resin restorations and stainless steel crowns for dependents under 12) |
50% |
Endodontics (root canal treatments and root canal fillings) |
50% |
Periodontics (treatment of the gums) |
|
MAJOR (Subject to deductible)
|
50% |
Special Restorative (individual permanent crowns) |
50% |
Prosthodontics (bridges, partial and complete dentures, including repairs and adjustments) |
|
ORTHODONTICS (Subject to deductible)
|
None |
Orthodontic appliances and treatment |
| |
Maximum Contract Benefit Per Person:
The maximum benefit payment for all covered dental procedures (excluding Dianostic and Preventive service) for each Eligible Person in amy one Calendar year is: $1,000.00 |
Deductible Limitations:
Coverage for diagnostic and preventive services is not subject to any deductible amount. For all other covered benefits, the calendar year deductible is: $25x3 |
Dependent Ages:
Dependents are covered to age Twenty-six (26). |
View Summary of Benefits
Monthly Premiums
| |
12 months |
9 months |
Employee |
$24.57 |
$32.76 |
Employee + Child(ren) |
$47.75 |
$ 63.67 |
Employee + Spouse |
$48.78 |
$65.04 |
Family |
$81.01 |
$108.01 |
