Eligibility:
Plan I Earned, Plan I Self-Pay and Senior Performers. View SPD
Plan II Earned and Plan II Self-Pay are covered if they have 3 years of Earned Eligibility. View SPD .
Lower Cost Self-Pay participants are covered under the dental plan they were covered under when they had Earned Eligibility.
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| Benefits | DeltaPreferred Network Dentist | DeltaPremier Dentist or Non-Network Dentist | |
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| Calendar Year Deductible | Plan I: $75/person;$200/family
Plan II: $100/person;no family maximum deductible | Plan I: $75/person;$200/family
Plan II: $100/person;no family maximum deductible | |
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Diagnostic & Preventive
Oral exams, cleanings, X-rays, fluoride treatments, sealants | 100%; deductible waived
| Plan I: 75%
Plan II: 60%
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Basic Services
Fillings, oral surgery, root canals, periodontics, general anesthesia | Plan I: 75%
Plan II: 60% | Plan I: 75%
Plan II: 60% | |
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Major Services
Inlays, crowns, bridges, dentures, implants | 50% | 50% | |
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| Maximums | Plan I: $2,500
Plan II: $1,000
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