Dental
Your dental plan promotes and encourages preventive dental care and provide benefits for services that are essential to good oral health.
Delta Dental PPO Plan
Your Delta Dental PPO Plus Premier coverage is administered by Delta Dental of Iowa. By encouraging preventive care, this dental program is designed to help contain dental costs.
- Choose any dentist at the time you need care.
- If you use an out-of-network provider, the plan pays only “reasonable and customary” (R&C) charges. You will be responsible for the difference.
Delta Dental of Iowa
Delta Dental PPO Benefits
| Delta Dental PPO | |
|---|---|
| In-Network and Out-of-Network | |
| Calendar Year Deductible | |
| Individual | $25 |
| Family | $75 |
| Calendar Year Plan Maximum | |
| Per Individual | $1,500 |
| Coinsurance/Copays | You Pay |
| Check-Ups and Teeth Cleaning | |
| Dental Cleaning, Oral Evaluation, Fluoride, Sealant, X-rays, Space Maintainers, Emergency Treatment | $0* |
| Cavity Repair and Tooth Extractions (Routine & Restorative) | |
| General & Sedation Anesthesia, Restoration of Decayed or Fractured Teeth, Limited Occlusal Adjustment, Routine Oral Surgery | 20% |
| Root Canals (Endodontic Services) | |
| Apicoectomy, Direct Pulp Cap, Pulpotomy, Retrograde Fillings, Root Canal Therapy | 20% |
| Gum and Bone Diseases (Periodontal Services) | |
| Conservative Procedures, Complex Procedures, Maintenance Therapy | 20% |
| High Cost Restorations (Cast Restorations) | |
| Crowns, Inlays, Onlays, Posts & Cores | 50% |
| Dentures and Bridges (Prosthetics) | |
| Dentures – 1 every 5 years | 20% |
| Bridges – 1 every 5 years | 50% |
| Implants (1 every 5 years) | 50% |
| Orthodontics* | |
| Covered for adults and children up to age 26 | 50% |
| Lifetime Orthodontia Plan Maximum (Per Individual) | $1,500 |
| * Deductible waived. | |