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Dental Plan
 

Good oral health is part of your total health picture. It’s not just about pearly whites and fresh breath; healthy teeth can help you maintain a healthy body. Please remember, you can visit any dentist you choose, however if you choose a network dentist you will not be required to pay any over reasonable and customary charges.

Dental SBC

Find a provider

To obtain a list of dentists participating in your Delta Dental network simply go to www.deltadental.com or call 800.335.8266

Dental Coverage
In-Network
Orthodontia Lifetime Max
$1,500
Calendar year deductible
$75 per person / $225 per family
Type I - Diagnostic and preventative services (oral exams, teeth cleaning, X-rays, etc.)
100%
Type II - Basic services (ancillary, fillings, extractions, etc.)
80%
Type III - Major services (oral surgery, crowns, dentures, etc.)
80%
Calendar year maximum benefit
$1,500 per person
Bi-Weekly Employee Rates
Employee
$14.24
Employee + Spouse
$28.17
Employee + Child(ren)
$28.07
Family
$47.83

Group Number

Network

Carrier Website

Customer Service Number

Premier

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52787

This summary of benefits is intended only to highlight your benefits and should not be relied upon to fully determine coverage.  Please refer to the summary of Benefits and Coverage (SBC) for a complete listing of services, limitations, exclusions and a description of all terms and conditions of coverage.  Where there is a discrepancy, the SBC will prevail.

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