Administration

Dental Insurance

 The College currently has two Dental Insurance plans provided by Delta Dental . The monthly premiums are listed below.  

High Plan - PDP
Monthly Cost
Low Plan - DHMO
Monthly Cost
 
 
 
 
Employee Only
$29.46
Employee Only
$11.96
Employee + Spouse/Partner
$61.86
Employee + Spouse/Partner
$20.92
Employee  + Child(ren)
$62.46
Employee + Child(ren)
$25.12
Employee + Family
$103.58
Employee + Family
$35.28
                   
                                                                                                      LOW PLAN
DeltaCare USA
With this plan there are no claim forms, no yearly deductible and no yearly maximums.
You must select a DeltaCare USA contracted dentist when you enroll by utilizing the online directory.
Please see the DeltaCare USA brochure for a list of services and associated co-pays. Click here to view the brochure.                                                                       
 
                      
HIGH PLAN
Delta Dental PDP
 
This plan allows you to select the dentist of your choice.
You may search for a participating Delta Dental PDP dentist by using the online directory.
 
 
 
Coverage Type In - Network Out - of - Network
Type A - Preventative 100% of PDP Fee 100% of R&C Fee
Type B - Basic Restorative 80% of PDP Fee 80% of R&C Fee
Type C - Major Restorative 50% of PDP Fee 50% of R&C Fee
Deductible In-Network Out-Of Network
Individual $50 $50
Family $100 $100
Annual Maximum Benefits In-Network Out - of - Network
Per Person $1000 $1000
 
In-Network Benefits means benefits under this plan for covered dental services that are provided by a Delta Dental PDP Dentist.
Out-of-Network Benefits means benefits under this plan for covered dental service that are not provided by a Delta Dental PDP Dentist.
PDP Fee refers to the fees that Delta Dental dentists have agreed to accept as payment in full.
Out-of-Network benefits are payable for service rendered by a dentist who is not a participating provider. The Reasonable and customary charge is based on the lowest of:
  • The dentist's actual charge
  • The dentist's usual charge for the same or similar services 
  • The usual sharge of most dentists in the same geographic area for the same or similar services as determined by Delta Dental. For your plan, the Customary Charge is based on the 90th Percentile. Services must be necessary in terms of generally accepted dental standards.                                                                                                                  
 
LIST OF COVERED SERVICES AND LIMITATIONS

 
Type A - Preventative How Many / How Often
Prophylaxis - Cleanings 1 cleaning in 6 months
Oral exams 1 oral exam in 6 months
Topical fluoride applications 1 fluoride treatment in 12 months for dependent children up to 19th birthday
Bitewing X-rays Adult - 1 time in 12 months / Child - 2 times in 12 months up to 19th birthday
Periodontal Maintenance 4 periodontal treatments in 1 year / includes 2 cleanings
Emergency palliative treatment  
Type B - Basic Restorative How Many / How Often
Full mouth X-rays 1 full mouth x-ray in 60 months
Endodontics - Root canal Root canal treatment limited to 1 per 24 months
Oral surgery -simple & surgical  
Periodontal surgery 1 per quandrant in any 36 month period
Periodontal scaling & root planing 1 per quandrant in any 24 month
Amalgam & composit fillings  
Type C - Major Restorative How Many / How Often
Bridges 1 in 10 years
Dentures 1 in 10 years
Crowns / Inlays / Onlays 1 replacement per 60 months
Prefabricated Stainless steel and Resin crowns 1 replacement per 60 months
     
 
 
 
 
 
 
 
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