Dental overview
Our Dental plan, provided by Delta Dental, allows you to access quality care through a network to smile about. By choosing a dentist within Delta Dental’s PPO Network, you’ll keep more dollars in your pocket.
To maximize coverage of your dental expenses, choose a Delta Dental PPO Dentist. But, if it’s better for your circumstances, you can choose a Delta Dental Premier Dentist or a Non-Participating Dentist. The tables below show a comparison of coverage.
How much does this benefit cost?
| Coverage type |
Associate cost per pay period |
| Associate only |
$12.33 |
| Associate + 1 |
$19.71 |
| Family |
$28.34 |
Class I
| |
Delta Dental PPO Dentist |
Delta Dental Premier Dentist |
Non-Participating Dentist |
| Diagnostic and Preventive Services – Used to diagnose and/or prevent dental abnormalities or disease (includes exams, cleanings) |
100% |
100% |
90% |
| Emergency Palliative Treatment – Used to temporarily relieve pain |
100% |
100% |
90% |
| Radiographs – X-rays |
100% |
100% |
90% |
| Sealants (to age 15) – Dental sealants to prevent decay of permanent molars |
100% |
100% |
90% |
Class II
| |
Delta Dental PPO Dentist |
Delta Dental Premier Dentist |
Non-Participating Dentist |
| Oral Surgery Services – Extractions and dental surgery, including preoperative and postoperative care |
90% |
80% |
60% |
| Minor Restorative Services – Used to repair teeth damaged by disease or injury (for example, amalgam [silver] and resin [white] fillings) |
90% |
80% |
60% |
| Endodontic Services – Used to treat teeth with diseased or damaged nerves (for example, root canals) |
90% |
80% |
60% |
| Relines and Repairs – Relines and repairs to bridges and dentures |
90% |
80% |
60% |
| Periodontic Services – Used to treat diseases of the gums and supporting structures of the teeth |
60% |
60% |
40% |
Class III
| |
Delta Dental PPO Dentist |
Delta Dental Premier Dentist |
Non-Participating Dentist |
| Major Restorative Services – Used when teeth can’t be restored with another filling material (for example, crowns) |
60% |
60% |
40% |
| Prosthodontic Services – Used to replace missing natural teeth (for example, bridges, implants and dentures) |
60% |
60% |
40% |
Class IV
| |
Delta Dental PPO Dentist |
Delta Dental Premier Dentist |
Non-Participating Dentist |
| Orthodontic Services (to age 19) – Used to correct malposed teeth and/or facial bones (for example, braces) |
60% |
60% |
60% |
| Maximum Payment |
$1,500 per person total per calendar year for Class I, Class II and Class III Benefits, excluding preventive cleanings and exams. Delta Dental’s payment for Class IV Benefits will not exceed a lifetime maximum of $2,000 per eligible person. |
| Deductible |
$25 per person total per calendar year limited to a maximum deductible of $75 per family per calendar year on Class II and Class III Benefits. The deductible does not apply to Class I or Class IV Benefits or the Delta PPO Network. |
How to make the most of this benefit
- Add dependent coverage – your spouse and any children through the month they turn age 26 are eligible.
- Choose a Delta Dental PPO Dentist to maximize coverage of your dental expenses.
- Combine this benefit with an HSA or Healthcare Flexible Spending Account to get eligible out-of-pocket expenses reimbursed.
- Request a pre-treatment estimate to find out whether a proposed dental treatment is covered, what amount the plan will pay, and what amount you will pay.
- Change your coverage at any time during the year if you have a relevant and qualified change in family status (e.g. you get married and want to add your spouse) – update your elections in Workday.
