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Benefits

Retiree - Delta Dental Basic

Delta Dental Basic offers choice and flexibility through a large network consisting of both the Delta Dental PPO in-network and the Delta Dental Premier in and out-of-network dentists.  

Delta Dental PPO in-network providers offer services at a lower negotiated fee schedule, resulting in lower member copays.  There is also no balance billing when utilizing a PPO dentist.

Delta Dental Premier in-network or out-of-network dentists are paid at a higher negotiated fee schedule.  With Premier network dentists, there will never be balance billing.

Go to www.deltadentalky.com to locate a provider.

In all cases, plan members are responsible for coinsurance, deductibles, and non-covered services.

Delta Dental Basic Plan Features

  • Diagnostic and preventive care to maintain good oral health.
  • 20% coinsurance after $25 deductible on minor restorative services.
  • Coverage for preventive and minor restorative procedures only.

Click here for full plan details.

Delta Dental Basic Summary of Benefits

 

Delta Dental Basic

Choosing a Dentist

Based on Delta Dental PPO & Premier in-network

Annual Deductible
Annual Plan Maximum

$25/person; $75/family
$1,000

Covered Benefit:

Routine Office Visit


100%

Preventive:
Two cleanings/calendar yr.

 

100%

Restorative Services:

Restorative filings


80%
Simple extractions 80%
Periodontic services 80%
Crown or bridge Not covered
Endodontics (root canal) 80%
Oral Surgery 80%
Complete/partial dentures Not covered
Orthodontics Not covered
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