The Fund’s Dental Program helps you pay for dental and orthodontic care for yourself and your covered dependents. You have a choice of two plans—both cover diagnostic, preventive, and restorative dental services. Orthodontic benefits are included in the Active Participant plan. A summary of key plan features are shown below. Also, you’ll find more details in your plan’s Benefit Chart and the Dental Program for Active Participants in All Plans and All Retirees.
Active Participants note that dental and orthodontia benefits are automatically included with medical coverage at no additional cost to you. You may opt-out by calling the Fund Office and completing the proper form. However, dropping your coverage will not reduce your weekly payroll deductions.
Retirees enrolled in the Retiree Dental Plan pay a monthly premium. Orthodontic benefits are not included in the Retiree Dental Plan.
Delta Dental PPO Plan Postcard
Delta Dental Summary of Material Modifications
Delta Dental PPO Plan Benefit Highlights
The coinsurance shown in the Delta Dental PPO Benefit Highlights reflects your cost-sharing responsibility. Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists.
Here are the Indemnity Dental Plan’s key features:
- Dental provider choice: You can seek care from any licensed dental provider.
- Deductible: You need to meet an annual deductible before the plan pays benefits for many non-preventive services. The deductible is waived for preventive and diagnostic procedures. The amount of the deductible is based on your benefit level (Platinum Plus, Silver, Gold, or Platinum) and your plan type (Plan A or Plan B).
- Calendar-year benefit maximum: Dental benefits are limited to a maximum amount for each calendar year for each person (age 19 and older). The amount of the benefit maximum is based on your benefit level (Platinum Plus, Silver, Gold, or Platinum) and your plan type (Plan A or Plan B). There is no annual benefit maximum for pediatric dental care (up to age 19).
- Dental plan payments: Payment for benefits are based on the Fund’s Schedule of Dental Allowances (for the previous year’s schedule, click here). Each procedure has an allowance. The plan pays its percentage of your dentist’s fee, provided the fee is not higher than the allowance. If your dentist charges a higher fee, you are responsible for paying the difference between your dentist’s fees and what the plan pays. To request a printed copy of the Schedule of Allowances, contact the Fund Office.
- Orthodontia: A lifetime maximum benefit applies for orthodontic treatment. Your share of the costs and the amount of the lifetime maximum are based on your benefit level (Platinum Plus, Silver, Gold, or Platinum) and your plan type (Plan A or Plan B).
You can use any orthodontist, but your out-of-pocket costs will likely be lower if you use a Network Panel Orthodontist. Network Panel Orthodontists have contracted with the Fund to limit their prices for orthodontia services. If you use an orthodontist who is not on the Network Panel, you pay coinsurance in the amount shown on your plan’s Benefits Chart, plus any costs that exceed the plan’s limits.
Here are the Prepaid Dental Plan’s key features:
- Dental provider choice: When you enroll in the Prepaid Dental Plan, you must select a Prepaid Dental Plan Office for your dental care. If you do not visit this Office, you are responsible for the full cost of your care. Here is a list of Prepaid Dental offices; the list is also provided with your plan enrollment materials and included in the Dental Program description booklet. You can also contact the Fund Office for a copy.
- Deductible: There is no deductible requirement under this plan.
- Calendar-year benefit maximum: There is no annual benefit maximum under this plan.
- Plan payments: The Prepaid Dental Plan provides many diagnostic, preventive, and restorative services at no charge to you. You pay a copayment for major dental work, such as dentures and root canals. You may also be required to pay for services that are not covered by the prepaid plan including porcelain surcharges for crowns on some teeth.
- Orthodontia: A lifetime maximum benefit applies for orthodontic treatment. Your share of the costs and the amount of the lifetime maximum is based on your benefit level (Platinum Plus, Silver, Gold, or Platinum) and your plan type (Plan A or Plan B).
You can use any orthodontist, but your out-of-pocket costs will likely be lower if you use a Network Panel Orthodontist. Network Panel Orthodontists have contracted with the Fund to limit their prices for orthodontia services. If you use an orthodontist who is not on the Network Panel, you pay coinsurance in the amount shown on your plan’s Benefits Chart, plus any costs that exceed the plan’s limits.