Health Plan Summaries

 

  • 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.

    Benefits Delta Dental PPO Provider Delta Premier Dentist and Non-Network Providers
    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
    Diagnostic & Preventive

    Oral exams, cleanings, X-rays, fluoride treatments, sealants    		 100% Plan I: 75%
    Plan II: 60%
    Basic Services

    Fillings, oral surgery, root canals, periodontics, general anesthesia    		 Plan I: 75%
    Plan II: 60%    		 Plan I: 75%
    Plan II: 60%
    Major Services

    Inlays, crowns, bridges, dentures, implants    		 50% 50%
    Maximums Plan I: $2,500
    Plan II: $1,000