Important Note:
- Be sure to ask whether you are making an appointment with a PPO or Premium service provider when making appointments to avoid unanticipated fees. It is possible for two dentists working in the same practice to be members of different networks.
Basic Plan Benefits
| ppo Provider | premier provider/ out of network provider | |
|---|---|---|
| Preventative and diagnostics | 100% | 100% |
| Fillings and simple extractions | 80% | 50% |
| Deductible | $50 | $50 |
| maximum | $1000 | $500 |
| ppo provider | premier provider/ Out of network provider | |
|---|---|---|
| preventative and diagnostics | 100% | 100% |
| fillings and simple extractions | 80% | 50% |
| sealants | 80% | 80% |
| root canals, periodontics, oral surgery | 50% | 50% |
| crowns and gold restorations, bridgework, dentures | 50% | 50% |
| deductible | $50 | $50 |
| maximum | $1500 | $1000 |
The annual premiums for dental coverage are as follows:
Basic Plan
| Basic plan option | Annual Premium |
|---|---|
| Single student | $312.72 |
| Student + One | $553.20 |
| Student + Family | $843.84 |
Enhanced Plan
| Basic plan option | Annual Premium |
|---|---|
| Single student | $563.40 |
| Student + One | $996.96 |
| Student + Family | $1,521.24 |
| Delta Dental PPO Plus Premier | PPO Provider | Premier/Out of Network Provider |
|---|---|---|
| Preventative and diagnostics, sealants | 100% | 100% |
| Fillings, simple extractions | 80% | 80% |
| Root canals, oral surgery | 80% | 80% |
| Crowns and gold restorations | 50% | 50% |
| Deductible | N/A | N/A |
| Annual maximum | $2,500 | $2,500 |
| Orthodontics Children only to age 19 Lifetime Maximum |
50% $1,000 |
50% $1,000 |
The Annual dental premiums are as follows:
| Plan Option | Annual Premium (PhD less than 3 year) |
Annual Premium (PhD 3rd year) |
|---|---|---|
| Single Student | $124.94 | $124.94 |
| Student +1 | $605.78 | $413.45 |
| Student + Family | $1,186.94 | $762.14 |
Note: if you elect payroll deduction the annual premium will be spread over seven pay periods.