Dental
You have two dental plan options to choose from:
- Core Plan
- Buy-Up Plan
Both provide the same core services; however, you have a higher level of coverage under the higher premium Buy-Up Plan. You may see a participating dentist in either the Delta Dental PPO network or the Delta Dental Premier network to receive in-network benefits. You will get the greatest discounts by using a Delta Dental PPO provider.
Contact Delta Dental
Connect with your dental plan by visiting deltadentalct.com or calling 1-800-452-9310.
Compare Options
Unless noted, you must satisfy the annual deductible before the plan pays benefits.
| Core Plan | Buy-Up Plan | |||
|---|---|---|---|---|
| In-network You Pay | Out-of-network You Pay | In-network You Pay | Out-of-network You Pay |
|
| Annual Deductible Individual Family | $50 $150 | $50 $150 | $25 $75 | $25 $75 |
| Annual Benefit Maximum (per person) | $1,500 | $1,500 | $2,250 | $2,250 |
| Preventive & Diagnostic • Exams and cleanings (each twice per calendar year) • Bitewing X-Rays (twice per calendar year up to age 18; once per calendar year for members 19+) | $0 (no deductible) | $0 (no deductible) | $0 (no deductible) | $0 (no deductible) |
| Basic Fillings (composite), simple extractions, root canals, periodontics, oral surgery, space maintainers, denture repair | 20% | 20% | 10% | 10% |
| Major Crowns and gold restorations, bridgework, full and partial dentures | 50% | 50% | 40% (implants are also covered) | 40% (implants are also covered) |
| Orthodontics • Children only to age 26 • Lifetime maximum | Not Covered | Not Covered | 50% $1,500 | 50% $1,500 |
Note: You will be responsible for any deductibles, co-payments, or cost share listed in the table above for both in-network and out-of-network dentists. Members utilizing out-of-network dentists may be balance billed for the difference between the dentist’s billed amount and the Delta Dental approved/paid amount. You will have no balance billing when using an in-network dentist. Most out-of-network dentists will submit claims to Delta Dental for their patients, however, they may request payment from you prior to services. If your out-of-network dentist will not submit the claim on your behalf, you can contact Delta Dental’s Customer Service team at 1-800-452-9310 for assistance.
2024 Dental Non-Union Employee Payroll Contributions
| Core Plan | Buy-up Plan | |||
|---|---|---|---|---|
| Weekly | Bi-Weekly | Weekly | Bi-Weekly | |
| Employee | $3.99 | $7.98 | $5.23 | $10.46 |
| Employee + Spouse | $7.98 | $15.95 | $10.46 | $20.91 |
| Employee + Child(ren) | $9.27 | $18.54 | $12.16 | $24.31 |
| Employee + Family | $14.31 | $28.63 | $18.77 | $37.54 |
You will be responsible for any deductibles, co-payments, or cost share listed in the table above for both in-network and out-of-network dentists. Members utilizing out-of-network dentists may be balance billed for the difference between the dentist’s billed amount and the Delta Dental approved/paid amount. You will have no balance billing when using an in-network dentist. Most out-of-network dentists will submit claims to Delta Dental for their patients, however, they may request payment from you prior to services. If your out-of-network dentist will not submit the claim on your behalf, you can contact Delta Dental’s Customer Service team at 1-800-452-9310 for assistance.