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Dental Benefits

Your 2022 Dental Benefits

Delta Dental, our dental plan provider, offers a large network, but you have the freedom to visit any dentist you like. If you use a network dentist, you'll usually pay less and you won't have to file paperwork or claims.

Non-Represented Employees Dental Coverage

  Plan 1 Ortho Plan 2 No Ortho
General Provisions In-Network Out-of-Network In-Network Out-of-Network
Provider Choice You can use any licensed dentist you choose; however, your out-of-pocket costs are likely to be less than when you use in-network providers, since benefits are based on negotiated fees. When you use out-of-network providers, you pay your percentage of the reasonable and customary (R&C) amount, plus any amounts the provider charges above R&C.
Annual Deductible $50 per covered person $50 per covered person
Annual Maximum Benefit $2,000 per person per year $1,000 per person per year
Plan Benefits
Preventive Services* 100%, no deductible 100% of R&C, no deductible 100%, no deductible 100% of R&C, no deductible
Basic Care 80% after deductible 80% of R&C after deductible 80% after deductible 80% of R&C after deductible
Oral Surgery 80% after deductible 80% of R&C after deductible 80% after deductible 80% of R&C after deductible
Major Restoration 50% after deductible 50% of R&C after deductible 50% after deductible 50% of R&C after deductible
Orthodontia 100% after annual deductible; $2,000 lifetime maximum per person Not covered

*Includes 2 cleanings per year

Local 396 Represented Employees and Local 1245 Represented Employees Dental Coverage

General Provisions In-Network Out-of-Network
Provider Choice You can use any licensed dentist you chose; however, your out-of-pocket costs are likely to be less when you use in-network providers, since benefits are based on negotiated fees. When you use out-of-network providers, you pay your percentage of the reasonable and customary (R&C) amount, plus any amounts the provider charges above R&C.
Annual Deductible $25 individual; $75 per family*
Annual Maximum Benefit $2,000 per person per year*
Preventive Services** 100%, no deductible 100% of R&C, no deductible
Basic Care 80% after deductible 80% of R&C after deductible
Oral Surgery 80% after deductible 80% of R&C after deductible
Major Restoration 50% after deductible 50% of R&C after deductible
Orthodontia 100% after annual deductible;$2,000 lifetime maximum per participant

*In- and out-of-network combined
**Includes two cleanings per year

To find a participating dentist or see if your dentist participates in the Delta Dental network, visit deltadentalins.com. Use the site for secure access to your personal plan information and to see the cost of dental procedures.

Reminder: No Delta Dental ID cards are provided or needed.