Great oral health is an essential part of taking care of your overall health. Through Delta Dental, we offer two dental plans that cover routine checkups and other dental care. The plans differ in how much you pay per pay period and how much you pay at the time of service.
Covered Services
Both dental plans provide benefits for:
- Preventive services, such as oral exams, cleanings and X-rays
- Basic services, such as fillings, extractions, root canal therapy, and treatment of gum disease
- Major services, such as crowns, bridge,s and dentures
The High plan also includes orthodontia coverage and provides more coverage for basic and dental services.
| Low Plan | High Plan | |
|---|---|---|
| Annual Deductible* | ||
| Employee | $50 | $50 |
| Family | $150 | $150 |
| Annual Maximum Payment** | ||
| Per Person, Per Calendar Year | $1,000 | $1,500 |
| Covered Services | ||
| Diagnostic & Preventive Services Exams, Cleanings, Fluoride, Sealants, X-rays | 0% | 0% |
| Basic Services Emergency Palliative Treatment, Minor Restorative Services, Periodontics, Endodontic | 20% | 10% |
| Major Services Crowns, Bridges, Implants, Dentures | 50% | 40% |
| Orthodontics (no age limit) | Not covered | 50% |
| Orthodontic Lifetime Benefit | N/A | $1,500 |
*$50 deductible per person total per calendar year limited to a maximum deductible of $150 per family per calendar year on all services except diagnostic and preventive services.
**Per person total per calendar year on diagnostic and preventive, basic services, and major services. Non-participating dentists are paid at the 90th percentile.
Benefit tip! You can also use your Health Care Flexible Spending Account—or, if you're enrolled in the High Deductible Health Plan, your Health Savings Account (HSA) or Limited-Purpose Flexible Spending Account—to pay for eligible dental expenses (that are not covered by another plan) on a pre-tax basis. Keep in mind that cosmetic procedures, such as teeth whitening, are not considered eligible expenses.
Locating a Dentist
To locate a participating dentist in your area, call 800-223-3104 or visit www.deltadentaltn.com
Benefit Plan Details
For complete plan details, please refer to the Summary Plan Description or Summary of Benefits.
See our Eligibility and Enrollment for details on who can enroll in health care coverage.
Click here for carrier contact details.