Dental Plan
Dental Plan
A dental plan helps pay for essential oral care that your medical plan doesn’t cover. But it’s important to keep in mind that a dental plan doesn’t limit your total out-of-pocket costs like a medical plan does.
Dental plans have an annual, per-person limit as to how much money the plan will pay for services. So you may want to space out more expensive dental work.
For Example
Jun has recently taken up skateboarding…and he now needs a few root canals and some crowns. The work is too expense to be fully covered under his annual limit, so Jun decides to do half of the work in December, right before the plan year ends, and then do the second half of the work in January, when the new plan year begins.
Splitting the work between the two plan years lets Jun stay below the annual limit, and save more money.
Some services have a lifetime, per-person maximum. Which means that, for those services, there’s only so much dental work the plan will help pay for, no matter many years you have the plan.
Now, when it comes to coverage, dental plans generally break work down into four categories:
Preventive Services, like exams, cleanings, and x-rays
Basic Services, which cover things like fillings and extractions
Major Services, which include root canals, crowns, bridges, oral surgery, and so on
Orthodontics, which include braces, retainers, etc.
The type of work determines what the coinsurance will be. The limits and coinsurance amounts are listed out in the table below, along with other plan details.
Speaking of plan details… Waters offers you a choice between the Delta Dental High Plan, and the Low Plan. Both plans use the same Delta Dental PPO Plus Premier network. The Low Plan is designed for people who are more interested in a lower premium cost, and only need preventive and basic services during the upcoming year.
| Delta Dental High Plan Showing in-network pricing only. The full plan summary, including out of network coverage, is located in the Learn – Resource Library of WatersBenefitsNow.com. | Delta Dental Low Plan Showing in-network pricing only. The full plan summary, including out of network coverage, is located in the Learn – Resource Library of WatersBenefitsNow.com. |
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|---|---|---|---|
| Premium | Employee only | $7.02/paycheck (bi-weekly rate) OR $7.61 (semi-monthly rate) ($182.52/year) | $4.68/paycheck (bi-weekly rate) OR $5.07 (semi-monthly rate) ($121.68/year) |
| Employee + children | $13.26/paycheck (bi-weekly rate) OR $14.37 (semi-monthly rate) ($344.76/year) | $9.36/paycheck (bi-weekly rate) OR $10.14 (semi-monthly rate) ($243.36/year) |
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| Employee + spouse/partner | $14.82/paycheck (bi-weekly rate) OR $16.06 (semi-monthly rate) ($385.32/year) | $10.14/paycheck (bi-weekly rate) OR $10.99 (semi-monthly rate) ($263.64/year) |
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| Family | $21.06/paycheck (bi-weekly rate) OR $22.82 (semi-monthly rate) ($547.56/year) | $14.82/paycheck (bi-weekly rate) OR $16.06 (semi-monthly rate) ($385.32/year) |
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| Deductible Deductible does not apply to Members under age 13 | Individual | $50 | $50 |
| Family | $150 | $150 | |
| Preventive Care | 100% covered | 100% covered | |
| Basic Care Members Under age 13 | Plan pays 80%/you pay 20% coinsurance (after deductible) Plan pays 100% | Plan pays 80%/you pay 20% coinsurance (after deductible) Plan pays 100% |
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Major Care Members Under age 13 | Plan pays 50%/you pay 50% coinsurance (after deductible) Includes Occlusal Mouth Guards. Plan pays 100% | Not Covered Plan pays 100% |
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| Annual Maximum | $2,000 per-person | $750 per-person | |
| Orthodontics Lifetime Maximum Orthodontics are available for adult members too! | $2,000 per-person Orthodontic costs do NOT count toward your annual, $2,000 per-person maximum | Not Covered | |
| TMJ Lifetime Maximum TMJ is "temporomandibular joint syndrome" | $750 per-person Unlike orthodontics, TMJ costs DO count toward your annual, $2,000 per-person maximum | Not Covered | |
The Delta Dental PPO Plus Premier Plan network of providers is divided into three groups, or tiers:
Delta PPO-providers in this tier will generally charge you the least for services
Delta Premier-providers in this tier have agreed to charge lower rates for their services if you are in the plan, though most likely not as low as providers in the Delta PPO tier
Out-of-network—providers in this tier have no negotiated rates with the plan
Visiting providers in the Delta PPO will likely save you the most money
For Example
Jun’s dentist is in the top tier, Delta PPO. While his dentist’s normal rate for a root canal is $500, the dentist has a negotiated rate with Jun’s plan for $325.
When Jun goes to get his root canal done, he first pays the $50 deductible himself, bringing the total down to $275. And since a root canal is considered a major service, he splits the $275 50/50 with the plan, leaving him with just $137.50 to cover.
Hannah’s dentist in the second tier, Delta Premier. Her dentist also normally charges $500 for a root canal, but only charges $400 to people in the Delta Dental PPO Plus Premier Plan network. (It’s a better rate than what her dentist charges out-of-network patients, but not as good as the one Jun got by going to a dentist in the Delta PPO tier.) Like Jun, Hannah pays the $50 deductible out-of-pocket, bringing the bill down to $350. She then splits that $350 50/50 with the plan, down to $175.
One last note…if you get your two preventive cleanings each year, Delta Dental will automatically carry over some of your unused available benefit to the next year to help cover the cost of any potential larger out-of-pocket dental costs. This is a great incentive to always get your two preventive cleanings, and great protection for the future, too! For further details, review the full Delta Dental Plan Summary location in the Learn – Resource Library of WatersBenefitsNow.com, or contact Delta Dental at: www.deltadentalma.com, or 1-800-872-0500.