Dental Plan Features
Dental Plan Features
The Dental Plan is administered by Delta Dental of Iowa.
The chart below provides an overview of how the dental plan works and how each type of service is covered by the dental plan. Please refer to the Dental Benefit Summary for complete details on the benefits.
| Service Category | Delta Dental PPO | Delta Dental Premier | Out-of-Network |
|---|---|---|---|
| Diagnostic & Preventive (exams/cleanings) | 100% | 100% | 100% |
| Basic Services (fillings) | 90% | 80% | 80% |
| Endodontics (root canals) | 60% | 60% | 60% |
| Periodontics (treatment relating to gum disease) | 60% | 60% | 60% |
| Oral Surgery (simple or complex oral surgery) | 60% | 60% | 60% |
| Major Restorative Services (crowns) | 60% | 60% | 60% |
| Prosthetic Services / Implants | 60% | 60% | 60% |
| Prosthetics (bridges/dentures) | 60% | 60% | 60% |
| Orthodontics (up to age 19) | 50% | 50% | 50% |
| Deductible (Does not apply to Preventive or Ortho) | $15 per person / $45 per family | $25 per person / $75 per family | $25 per person / $75 per family |
| Annual Maximum | $2,000 per calendar year | ||
| Orthodontia Lifetime Maximum | $1,000 Lifetime Maximum | ||
Dental Plan Premiums
Dental Plan Premiums
| 2021 Team Member Cost Per Month | |
|---|---|
| Delta Dental Plan Premiums | |
| Employee | $5.17 |
| Family | $16.67 |
Find a Dentist
Find a Dentist
To see if your dentist participates in the Delta Dental network or to find a new dentist, visit Delta Dental’s website here.
Dental Plan Summary of Benefits