Employee Dental Plans (Mandatory)
Administered by Delta Dental, 1-866-579-5717
Who is Eligible?
Benefits eligible employees, COBRA enrollees, and their eligible dependents.
Benefits eligible employees enrolling in the Choices Medical Plan must elect a Dental Plan (Basic Plan or Select Plan). Note: the Basic Plan provides coverage for a limited range of services including diagnostic and preventive services.
During annual enrollment, benefits eligible employees may change their Dental Plan option and add eligible dependent children to the Dental Plan. Important Note: Annual enrollment for the Plan year is Closed Enrollment for a legal spouse for Dental coverage unless there is a qualifying event.
Dental claims are reimbursed based on a fee schedule. The fee schedule dollar amount
is the maximum reimbursement for the specified dental procedure code. Dental Plan
enrollees are responsible for the difference (if any) between the provider's charge
and the fee schedule reimbursement amount. Refer to the Summary Plan Description
(SPD) on the Choices home page for complete Dental Plan benefits, Plan exclusions, and fee schedule information.
Basic Plan Coverage
Select Plan Coverage
|Annual Benefit Maximum||$750 per covered individual||$2,000 per covered individual|
|Preventive and Diagnostic Services||
**The Preventive & Diagnostic Services listed above do not apply to the $2,000 annual benefit maximum
|Basic Restorative Services||
|Major Dental Services||
The Select Plan provides a $1,500 lifetime orthodontic benefit per covered individual. Benefits are paid at 50% of the allowed amount for authorized services. Treatment plans usually include an initial down payment and ongoing monthly fees. If an initial down payment is required, Choices will pay up to 50% of the initial payment, up to 1/3 of the total treatment charge. In addition, Delta Dental (Dental Plan Administrator) will establish a monthly reimbursement based on the provider’s monthly fee and the prescribed treatment plan.