Apply Online for an Individual and Family Dental Plan
Online Application
If you are looking for information on Health Care Reform & Exchange Certified Dental Plans, please click on Exchange Certified Plans above and it will direct you to our Exchange plans.
Delta Dental's Individual and Family Pre-Paid Dental Plans offer you comprehensive dental benefits at an affordable price.
Preferred
Basic
Annual Deductible per person
$50
$75
Annual Maximum per person
$1200
$1000
Preventive & Diagnostic Benefits
Exams
Prophylaxis (Cleaning)
Bitewing x-rays/Full Mouth x-rays
Child Topical Fluoride
Child Sealants
100%
There is no waiting period on Preventive & Diagnostic Services
80%
Basic Services
Space Maintainers
Amalgam Restorations/Silver Fillings in permanent & primary teeth
Synthetic Restorations/White Fillings on anterior teeth
Stainless Steel Crowns
Simple Extractions
Emergency Treatment for the Relief of Pain
50%
There is a six month waiting period on Basic Services
Major Services
Oral Surgery (impacted teeth and/or wisdom teeth)
Periodontics
Root Canals
Crowns/Crown Build-up
Bridges
Dentures
Implants
There is a 12 month waiting period on Major Services
Percentages shown are what Delta Dental of Wyoming pays after the per person deductible has been met.
Preferred Plan Rates
Basic Plan Rates
Monthly
(Bank Draft)
Annual (Check)
Individual
$40.50
$486.00
$32.00
$384.00
Individual + One
$81.00
$972.00
$64.00
$768.00
Individual + Family
$119.95
$1,439.40
$96.00
$1,152.00
Coverage is effective the first of the month after the application is received by Delta Dental of Wyoming.
If you would like to view a copy of the application and brochure please click on the links below. You may also print the application below off the website, complete it and mail it to our office in Cheyenne at:
Please note, this policy requires 30-day written notice for termination.
Individual and Family Dental Plans Brochure
Individual and Family Dental Plan Application
Coverage Change Form - Individual and Family Plan