Delta Dental Coverage Options

As of January 1, 2023, Delta Dental Option B will be available in addition to Delta Dental Option A. You may elect this coverage option during annual enrollment, which will take place from November 4 to 18, 2022.

Delta Dental PPO Network

With Delta Dental, you have the option of seeing in-network providers, Premier Network providers and out-of-network providers:

• Delta Dental PPO In-Network Providers: You may obtain services from any of Delta Dental’s 377,500 PPO network provider locations nationwide. With a PPO provider, the cost of services has been negotiated to get the most competitive rates and is generally the lowest cost to members.
• Delta Dental Premier Network Providers: You may obtain services from the Delta Dental Premier network of approximately 442,700 provider locations. Providers participating in the Premier network have contracted their service fees directly with Delta Dental and may be lower than out-of-network providers. While in-network providers (above) still offer the most competitive rates, the Premier Network is a better alternative to out-of-network providers. If you use a Premier Network provider, your dental plan benefits will mirror the out-of-network plan design.
• Out-of-Network: You may obtain services from any out-of-network provider of your choice, but the cost will generally be the highest.

Dental Services

• Diagnostic and preventive services: X-rays and cleanings
• Restorative services: fillings, oral surgery, root canals and gum treatments
• Prosthodontics: crowns, bridges, dentures and implants

Note: Out-of-network reimbursements and maximums are based on reasonable and customary (R&C) charges as determined by each Dental Plan administrator. Please refer to the Health Benefits and Insurance Summary Plan Description for details.

Orthodontics Lifetime Maximum Benefit

The orthodontics lifetime benefit maximum is combined across plan options.
 

A Note About Annual Benefit Maximums

In no event can any one person receive more than the annual benefit maximum during a calendar year (excluding orthodontics), even if provided by an in-network or Premier Network dentist.
 

Dental Contributions

You and the Firm share the cost of your Dental Plan coverage. Your contributions are deducted from your pay on a before-tax basis.

Note: Your location and salary band are used to calculate only your medical contribution rates.
The costs shown below are per paycheck contributions. For the monthly cost, double the amounts shown.

If you are covering a domestic partner or the children of a domestic partner, the IRS determines the tax status of a dependent and may impose a tax on the value of coverage. Consult your tax advisor for more information.