Dental
Dental coverage helps you maintain a healthy smile with preventive care, basic services, and major procedures. You can visit any licensed dentist, but you’ll save the most when you use an in-network provider who has agreed to discounted rates. Out-of-network dentists may charge more than the plan’s allowed amount, and you may be responsible for the difference. Most plans cover preventive services—such as exams, cleanings, and X-rays—at 100% when you stay in-network, making regular checkups an easy way to protect your oral health and avoid costly issues.
DeltaCare USA (CA Only)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Annual Plan Maximum
None
Preventive Care
$0
Basic Services
$0-$220 copay – See schedule of benefits
Major Procedures
$0-$195 copay – See schedule of benefits
Orthodontia (Adults and Children)
$1,900 copay/$1,700 copay
Plan Cost
Employee Only: $3.67
Employee + 1: $9.18
Employee and Family: $12.55
Delta Dental PPO Low
Benefit Highlights
In-Network
Deductible (Individual/Family)
$100/$300
Annual Plan Maximum
$1,000; Combined In-Network and Out-of-Network
Preventive Care
$0
Basic Services
20% after deductible
Major Procedures
50% after deductible
Orthodontia (Adults and Children)
Not covered
Out-of-Network
Deductible (Individual/Family)
$100/$300
Annual Plan Maximum
$1,000; Combined In-Network and Out-of-Network
Preventive Care
20% after deductible
Basic Services
40% after deductible
Major Procedures
50% after deductible
Orthodontia (Adults and Children)
Not covered
Plan Cost
Employee Only: $4.03
Employee + 1: $8.32
Employee and Family: $11.80
Delta Dental PPO High
Benefit Highlights
In-Network
Deductible (Individual/Family)
$50/$150
Annual Plan Maximum
$2,500; Combined In-Network and Out-of-Network
Preventive Care
$0
Basic Services
10% after deductible
Major Procedures
40% after deductible
Orthodontia (Adults and Children)
50% up to a Lifetime Maximum of $1,000
Out-of-Network
Deductible (Individual/Family)
$50/$150
Plan Maximum
$2,500; Combined In-Network and Out-of-Network
Preventive Care
$0
Basic Services
20% after deductible
Major Procedures
50% after deductible
Orthodontia (Adults and Children)
50% up to a Lifetime Maximum of $1,000
Plan Cost
Employee Only: $8.85
Employee + 1: $18.31
Employee and Family: $28.72

