Please click on the links below to see a outline of selected plans.
VOLUNTARY POOL PLAN
GROUP DENTAL PLANS 3000, 3001
(With Orthodontics)
GROUP DENTAL PLANS 5000, 5001 (With Orthodontics)
GROUP DENTAL PLANS 6000, 6001 (With Orthodontics)
"THE LIMITED PLAN" GROUP DENTAL PLAN 7500 (A
Limited Plan)
Please Call Delta Dental - Marketing Services for a quote
1-800-735-3379.
Eligible Enrollees: Full-time employees of an employer group; employer must handle administration of the plan.
Participation Requirements: 50% employees and 50% dependents. (Participation requirements are rounded up to the next whole number).
Late Enrollment: 12 month wait before benefits are available.
Group Minimum Group Size: 5 Full-time employees.
BENEFITS
100% COVERAGE FOR DIAGNOSTIC AND PREVENTIVE SERVICES
Routine periodic examinations at six-month intervals, including bitewing
x-rays.
Dental prophylaxis (cleaning) as prescribed by the dentist, but not more
than once every six months.
75% COVERAGE FOR BASIC SERVICES
Sealants
Simple extractions
Fillings
Maximum $500.00 per person per calendar year.
Waiting Periods: Six month wait on Basic Services.
BENEFITS
100% COVERAGE FOR DIAGNOSTIC AND PREVENTIVE SERVICES
Routine periodic examinations at six-month intervals, including bitewing
x-rays.
Dental prophylaxis (cleaning) as prescribed by the dentist, but not more
than once every six months.
75% COVERAGE FOR BASIC SERVICES
Sealants
Simple extractions
Fillings
50% COVERAGE FOR MAJOR SERVICES
Pulpal and root canal filling.
Treatment of diseases of the tissues supporting the
teeth.
Crowns when teeth cannot be restored with a filling material.
Prosthetics - provides bridges, partial dentures and complete dentures.
Oral Surgery
Maximum $1,000.00 per person per calendar year.
Waiting Periods: Six month wait on Basic Services, and 18 month wait on Major Services.
Orthodontics: Orthodontics may be made available to groups with at least 20 enrolled employees. The benefit is 50% with a $750 lifetime maximum, after an 18-month waiting period. The cost is $7.50 added to the Employee + Child(ren) rate and $10.00 to the Family rate. Orthodontics are a benefit for dependent children only to age 19.
Delta Dental Premier - Fee For Service Plan
GROUP DENTAL PLANS 3000, 3001 (With Orthodontics)
BENEFITS
100% Coverage for Diagnostic and Preventive Services
Routine periodic examinations at six-month intervals, including bitewing
x-rays.
Full mouth x-rays once in a three-year interval, unless special need is
shown.
Dental prophylaxis (cleaning) as prescribed by the dentist, but not more
than once every six months.
Topical fluoride applications as prescribed by the dentist, but not more
than once in any 12-month interval. (Dependents under
the age of 19).
Space maintainers, fixed (band type). (Dependents
under the age of 19).
Sealants. (Dependents
under the age of 19).
50% Coverage for Basic Services
Emergency treatment for relief of pain.
Extractions and other oral surgery.
Amalgam, preformed crowns, synthetic porcelain, plastic and composite
restorations (fillings).
50% Coverage for Endodontics and Periodontics
Pulpal and root canal filling.
Treatment of diseases of the tissues supporting the
teeth.
50% Coverage for Major Services (six-month waiting
period unless plan had previous coverage).
Crowns when teeth cannot be restored with a filling material.
Prosthetics - provides bridges, partial dentures and complete dentures.
Maximum $1,000.00 per person per calendar year.
Deductible $50.00 per person per
calendar year not to exceed $100.00 per family unit.
Deductible does NOT apply to Diagnostic and Preventive Services.
Group Sizes: 3-49 & 50-99
Please refer to Delta Dental’s Underwriting Guidelines for underwriting information. All groups over 99 must be underwritten.
UNDERWRITING GUIDELINES
This dental program proposal is based on 100% enrollment of eligible employees. If an employer elects to include coverage for dependents, enrollment is based on at least 75% dependent enrollment. An employer may elect to provide coverage only for their employees, thereby making all dependents ineligible.
Limitations
Missing tooth limitation.
6 month waiting period for major services (unless
group has uninterrupted dental coverage for past 12 months). Applies to all new employees.
Orthodontics limitation: group size, waiting period.
This is a brief description of benefits.
Delta Dental Premier
- Fee For Service Plan
GROUP DENTAL PLANS 5000, 5001 (With
Orthodontics)
BENEFITS
80% Coverage for Diagnostic and Preventive Services
Routine periodic examinations at six-month intervals, including bitewing
x-rays.
Full mouth x-rays once in a three-year interval, unless special need is
shown.
Dental prophylaxis (cleaning) as prescribed by the dentist, but not more
than once every six months.
Topical fluoride applications as prescribed by the dentist, but not more
than once in any 12-month interval. (Dependents under
the age of 19).
Space maintainers, fixed (band type). (Dependents
under the age of 19).
Sealants. (Dependents
under the age of 19).
80% Coverage for Basic Services
Emergency treatment for relief of pain.
Extractions and limited other oral surgery benefits.
Amalgam, preformed crowns, synthetic porcelain, plastic and composite
restorations (fillings).
80% Coverage for Endodontics and Periodontics
Pulpal and root canal filling.
Treatment of diseases of the tissues supporting the
teeth.
50% Coverage for Major Services (six month waiting period unless plan
had previous coverage)
Crowns when teeth cannot be restored with a filling material.
Prosthetics - provides bridges, partial dentures and complete dentures.
Maximum $1,000.00 per person per calendar year.
Deductible $50.00 per person per
calendar year not to exceed $100.00 per family unit.
Deductible does NOT apply to Diagnostic and Preventive Services.
Group Sizes: 5-49 & 50-99
Please refer to Delta Dental’s Underwriting Guidelines for underwriting information. All groups over 99 must be underwritten.
UNDERWRITING GUIDELINES
This dental program proposal is based on 100% enrollment of eligible employees. If an employer elects to include coverage for dependents, enrollment is based on at least 75% dependent enrollment. An employer may elect to provide coverage only for their employees, thereby making all dependents ineligible.
Limitations
Missing tooth limitation.
6 month waiting period for major services (unless
group has uninterrupted dental coverage for past 12 months). Applies to all new employees.
Orthodontics limitation: group size, waiting period.
This is a brief description of benefits.
Delta Dental Premier
- Fee For Service Plan
GROUP DENTAL PLANS 6000, 6001 (With
Orthodontics)
BENEFITS
100% Coverage for Diagnostic and Preventive Services
Routine periodic examinations at six-month intervals, including bitewing
x-rays.
Dental prophylaxis (cleaning) as prescribed by the dentist, but not more
than once every six months.
Topical fluoride applications as prescribed by the dentist, but not more
than once in any 12-month interval. (Dependents under
the age of 19).
Space maintainers, fixed (band type). (Dependents
under the age of 19).
80% Coverage for Basic Services
Emergency treatment for relief of pain.
Extractions and limited oral surgery benefits.
Sealants.
Amalgam, preformed crowns, synthetic porcelain, plastic and composite
restorations (fillings).
Full mouth x-rays once in a five-year interval, unless special need is
shown.
80% Coverage for Endodontics and Periodontics
Pulpal and root canal filling.
Treatment of diseases of the tissues supporting the
teeth.
Lifetime maximum $1000.00 (Periodontics).
50% Coverage for Major Services (six-month waiting period).
Crowns when teeth cannot be restored with a filling material.
Prosthetics - provides bridges, partial dentures and complete dentures.
Maximum $1,000.00 per person per calendar year.
Deductible $50.00 per person per
calendar year not to exceed $100.00 per family unit.
Deductible does NOT apply to Diagnostic and Preventive Services.
Group Sizes: 5-49 & 50-99
Please refer to Delta Dental’s Underwriting Guidelines for underwriting information. All groups over 99 must be underwritten.
UNDERWRITING GUIDELINES
This dental program proposal is based on 100% enrollment of eligible employees. If an employer elects to include coverage for dependents, enrollment is based on at least 75% dependent enrollment. An employer may elect to provide coverage only for their employees, thereby making all dependents ineligible.
Limitations
Missing tooth limitation.
6 month waiting period for major services (unless groups with continuous
prior coverage for 12 months and on all new employees).
Orthodontics limitation: group size, waiting period.
Other oral surgery - excluding extractions.
This is a brief description of benefits.
Delta Dental Premier
Plan - Fee For Service Plan
"THE LIMITED PLAN" GROUP DENTAL PLAN 7500 (A Limited Plan)
BENEFITS
100% Coverage for Diagnostic and Preventive Services
Routine periodic examinations at six-month intervals, including
bitewing x-rays.
Full mouth x-rays once in a three-year interval, unless special need is
shown.
Dental prophylaxis (cleaning) as prescribed by the dentist, but not more
than once every six months.
Topical fluoride applications as prescribed by the dentist, but not more
than once in any 12-month interval. (Dependents under
the age of 19).
Space maintainers, fixed (band type). (Dependents
under the age of 19).
Sealants. (Dependents
under the age of 19).
50% Coverage for Basic Services
Emergency treatment for relief of pain.
Simple extractions.
Amalgam, preformed crowns, synthetic porcelain, plastic and composite
restorations (fillings).
Maximum $500.00 per person per calendar year.
Deductible $50.00 per person per
calendar year not to exceed $100.00 per family unit.
Deductible does NOT apply to Diagnostic and Preventive Services.
Group Sizes: 2-49 & 50-99
Please refer to Delta Dental's Underwriting Guidelines for underwriting information. All groups over 99 must be underwritten.
UNDERWRITING GUIDELINES
This dental program proposal is based on 100% enrollment of eligible employees. If an employer elects to include coverage for dependents, enrollment is based on at least 75% dependent enrollment. An employer may elect to provide coverage only for their employees, thereby making all dependents ineligible.
Limitations
Restorative: Gold restorations, crowns and synthetic restorations
on posterior teeth are optional and not a benefit. An allowance equal to
that for silver amalgam restoration will be made in such cases.
Prosthetics: Bridges, partial dentures, and complete dentures are not a covered benefit of this plan.
This is a brief description of benefits.