Dental Plan Options
Base PPO Dental Plan (Delta Dental PPO network only)
Annual Maximum Benefit $1,000 per person
Orthodontia Lifetime Maximum Benefit $1,000 per person
Deductible $50 Individual $150 Family
Preventive Services No cost (plan pays 100%)
Basic Services You pay 50% after deductible
Major Services You pay 70% after deductible
Orthodontia (for children up to age 19) You pay 50%
Buy-Up PPO Dental Plan (Delta Dental PPO or Premier networks)
Annual Maximum Benefit $1,500 per person
Orthodontia Lifetime Maximum Benefit $2,000 per person
Deductible $50 Individual $150 Family
Preventive Services (PPO | Premier) No cost (plan pays 100%) | You pay 20%
Basic Services (PPO | Premier) You pay 20% after deductible | 50%
Major Services (PPO | Premier) You pay 50% after deductible
Orthodontia (for children up to age 19) You pay 50%
Your Monthly Cost
Base PPO Dental Plan (Delta Dental PPO network only)
Employee $7
Employee & One Dependent $26
Employee & Two or More Dependents $56
Buy-Up PPO Dental Plan (Delta Dental PPO or Premier networks)
Employee $10
Employee & One Dependent $37
Employee & Two or More Dependents $75
Find a Dentist
Choose from two dental networks: Delta Dental PPO and Delta Dental Premier. A Delta Dental PPO provider will always cost you less out-of-pocket, so choose PPO for the greatest savings!
Find a network dentist at deltadentalco.com or with the Delta Dental mobile app.
- Base PPO Plan: This plan is in-network only. You must visit a Delta Dental PPO dentist to receive benefits.
- Buy-Up PPO Plan: It's your choice! This plan covers dentists in the Delta Dental PPO and Premier networks. It also has out-of-network coverage, but you will pay the most if you choose an out-of-network dentist. It's always smart to choose Delta Dental PPO dentist when you can.
Delta Dental Mobile App
Access your benefits and the tools to help you use it anytime, anywhere with the Delta Dental mobile app.
Vision Plan Option
EyeMed Select Vision Plan
Exam (every 12 months): You pay $10 copay
Contacts Fitting & Follow-Up: You pay up to $40 copay
Frames (every 24 months) $120 allowance, 20% discount on remaining balance
Lenses (every 12 months) Single, Bifocal, Trifocal: You pay $25 copay
Standard & Premium Progressive lenses: You pay $25 copay, then you pay 80% of charge less $55 allowance
Contact Lenses (every 12 months instead of glasses) $135 allowance, 15% discount on remaining balance (covered in full if medically necessary)
Your Monthly Cost
EyeMed Select Vision Plan
Employee $6.14
Employee & One Dependent $11.66
Employee & Two or More Dependents $17.14