Dental
Dental coverage is administered through Delta Dental
With your dental benefit program, you are free to go to any licensed dentist. However, you will save the most money by visiting a dentist in the Delta Dental PPO or the Delta Dental Premier network. Non-network dentists have not agreed to accept Delta Dental’s fees, which means they may bill for any charges over the allowed amount.
To search for in-network providers, visit www.deltadentalil.com or call 1-800-323-1743.
Dental Benefits
| Plan Design | Delta Dental PPO Network* | Delta Dental Premier Network** | Non-Network*** | |||
|---|---|---|---|---|---|---|
| Annual Deductible (Individual/Family) | $50 /$150 | |||||
| Annual Maximum | $1,500 / person | |||||
| Lifetime Orthodontic Maximum: (Dependent Children to Age 19 & Adults) | $1,500 / person | |||||
| Diagnostic and Preventive Care: Includes cleanings, fluoride treatments, sealants and x-rays | 100% | 100% | 100% | |||
| Basic Services: Includes fillings, periodontics, scaling and root planning, and oral surgery | 80% | 80% | 80% | |||
| Major Services: Includes crowns, bridges and full and partial dentures | 50% | 50% | 50% | |||
| Orthodontia Services: Lifetime Ortho Maximum | 50% | 50% | 50% | |||
* Delta Dental PPO dentists accept payment based on Delta’s maximum allowed fees. This is usually the highest discount available to members.
** Delta Dental Premier dentists accept payment based on a higher maximum of allowed fees. Members may pay more out of pocket.
*** Non-network dentists do not accept payment based on Delta’s maximum allowed fees. Members are responsible for any balance billing.
Delta Dental PPO and Premier dentists cannot balance bill members for the difference between Delta’s allowed fee and the submitted charge.
Employee Contributions
| Bi-Weekly Dental Contributions | ||
|---|---|---|
| Employee | $4.20 | |
| Family | $12.92 | |
Delta Dental Highlight Summary
