Dental – Delta Dental Plan
Contact information
- Phone: 800-524-0149
- Website: www.deltadentalin.com
- Create your account on their website to find providers, view benefits, claims, print/request an ID card
- Mobile app – click here
Summary plan documents
Please click here for an At a Glance summary offered under the lay employee plan
Please click here for a full Benefit Summary offered under the lay employee plan
Delta Dental PPO
Our dental plan takes advantage of network cost savings while continuing to offer a high-quality benefit. You may see any dentist you choose either in or out of the network. However, if you choose a network dentist you are assured your dentist will bill you for services at negotiated, discounted rates.
DELTA OFFERS 2 NETWORKS ALLOWING FOR MORE CHOICES
Effective January 1, 2017, Delta is the administrator for our dental plan networks and claims payment. Delta offers two large networks of providers in Indiana – Delta Dental PPO and Delta Dental Premier. To find a network dentist in either network, use the provider directory found on their website www.deltadentalin.com or by calling their customer service at 800-524-0149.
What is the difference between the two networks? Though your benefit level for dental services will remain the same regardless of the participating status of the dentist, your out-of-pocket costs will likely be the lowest if you use a Delta Dental PPO provider. This is because Delta Dental PPO providers have agreed to accept a lower fee (in other words, they’ve agreed to a larger claim discount) than Delta Dental Premier dentists would accept. Because your copayments (if any) are based on a percentage of this fee, the dollar amount of the copayment will be lower if the dentist accepts a lower fee.
ADVANTAGES OF SEEING A NETWORK DENTIST
- Deductible will be waived for diagnostic and preventative services.
- Submit claims for you and payment will be sent directly to your dentist.
- Only charges you for your copayment and deductible, if any.
- Out-of-pocket costs are likely lower.
DISADVANTAGES OF SEEING A NON-NETWORK DENTIST
You can see any dentist you choose. But you should know that seeing a non-network dentist,
- they may require you to submit your own claims.
- you may be responsible for making full payments to your dentist at the time of service.
- Delta Dental will send you a reimbursement check for amount covered under your plan
2024 payroll deductions
Single: $4.79/pay period
Family: $24.74/pay period
Brief Summary – 2024
| Plan Feature |
In Network (PPO and Premier) Plan Pays: |
|
|
| Annual Maximum Benefit |
$750 per person for all services except ortho; ortho is $1500 per person lifetime maximum |
Diagnostic & Preventive Services
Exams
Cleanings
Fluoride
Space maintainers
X-rays |
Covered 100%.
Deductible: $0 |
Basic Services
Emergency palliative treatment – temporarily relieve pain Minor Restorative Services – fillings, crown repair Endodontic Services – root canals
Periodontic Services – cleanings following periodontal therapy
Simple Extractions – non-surgical removal of teeth Other oral surgery – dental surgery |
Covered at 80% after deductible.
Deductible: $50/person; $100/family per calendar year
|
Major Services
Relines and repairs – to bridges, implants and dentures
Major restorative services – crowns
TMD Treatment – treatment of the disorder of the temporomandibular joint including related films Prosthodontic services – bridges, implants and dentures |
Covered at 50% after deductible.
Deductible: $50/person; $100/family per calendar year |
| Orthodontic services – braces up to the age of 19 |
Covered at 50% after deductible.
Deductible: $50/person; $100/family per calendar year |
REMINDER!
Your out-of-pocket expenses for dental care, including your deductible and co-insurance costs, are eligible for reimbursement through your Health Savings Account. (Or for those not electing the HSA, you may be reimbursed through a Flexible Spending Account or Health Reimbursement Account.)
