Dental & Vision
What does dental cover?
Dental and vision are one package: you choose them together.
Dental Plan Basics
- Coverage for preventive, basic, and major services.
- Includes orthodontic care for dependents.
- You're free to choose your own dentist!
- Also covers emergency dental care.
What comes out of your paycheck, per week
Dental and Vision · per week
| Coverage | Tier 1 | Tier 2 | Tier 3 |
|---|---|---|---|
| Just you | $8 | $9 | $10 |
| You + children | $10 | $11 | $12 |
| Family | $12 | $13 | $14 |
Dental and Vision · per week
| Coverage | Per week |
|---|---|
| Just you | $8 |
| You + children | $10 |
| Family | $12 |
What is covered
The table includes diagnostic and preventive services; basic services; oral surgery; endodontics; periodontics; major restorative services; prosthetic repairs, adjustments and prosthetics; orthodontics; and a TMJ lifetime maximum.
Your share and plan maximums
| Benefit | Delta Dental PPO | Delta Dental Premier | Out-of-network |
|---|---|---|---|
| Individual Deductible/ Family Deductible | $50/ $150 | $50/ $150 | $50/ $150 |
| Plan Annual Maximum Payment (per covered person) | $3,000 | $3,000 | $3,000 |
| Diagnostic and Preventive | 0% | 0% | 0% |
| Restorative Care | 20%* | 20%* | 20%* |
| Temporomandibular Joint (TMJ) Disorder | $1,500 | $1,500 | $1,500 |
| Orthodontia | 50% up to $3,000 | 50% up to $2,500 | 50% up to $2,500 |
*After deductible
Before treatment
- 1
Confirm whether the dentist is Delta PPO, Delta Premier or nonparticipating.
- 2
Review deductibles, maximums and your share with Delta Dental.
- 3
Keep documents for any reimbursement claim.