Dental – Delta Dental Plan

Contact information

  • Phone:  800-524-0149
  • Website:
  • Create your account on their website to find providers, view benefits, claims, print/request an ID card
  • Mobile app – click here

Summary plan documents

Please click here for an At a Glance summary offered under the lay employee plan

Please click here for a full Benefit Summary offered under the lay employee plan

Delta Dental PPO

Our dental plan takes advantage of network cost savings while continuing to offer a high-quality benefit. You may see any dentist you choose either in or out of the network. However, if you choose a network dentist you are assured your dentist will bill you for services at negotiated, discounted rates.


Effective January 1, 2017, Delta is the administrator for our dental plan networks and claims payment. Delta offers two large networks of providers in Indiana – Delta Dental PPO and Delta Dental Premier.  To find a network dentist in either network, use the provider directory found on their website or by calling their customer service at 800-524-0149.

What is the difference between the two networks? Though your benefit level for dental services will remain the same regardless of the participating status of the dentist, your out-of-pocket costs will likely be the lowest if you use a Delta Dental PPO provider. This is because Delta Dental PPO providers have agreed to accept a lower fee (in other words, they’ve agreed to a larger claim discount) than Delta Dental Premier dentists would accept. Because your copayments (if any) are based on a percentage of this fee, the dollar amount of the copayment will be lower if the dentist accepts a lower fee.


  1. Deductible will be waived for diagnostic and preventative services.
  2. Submit claims for you and payment will be sent directly to your dentist.
  3. Only charges you for your copayment and deductible, if any.
  4. Out-of-pocket costs are likely lower.


You can see any dentist you choose. But you should know that seeing a non-network dentist,

  1. they may require you to submit your own claims.
  2. you may be responsible for making full payments to your dentist at the time of service.
  3. Delta Dental will send you a reimbursement check for amount covered under your plan

2021 payroll deductions

Single:  $4.56/pay period

Family:  $23.56/pay period

Brief Summary – 2021

Plan Feature In Network (PPO and Premier) Plan Pays:
Annual Maximum Benefit $750 per person for all services except ortho; ortho is $1500 per person lifetime maximum

Diagnostic & Preventive Services

Space maintainers

Covered 100%.

Deductible:  $0

Basic Services

Emergency palliative treatment – temporarily relieve pain Minor Restorative Services – fillings, crown repair Endodontic Services – root canals
Periodontic Services – cleanings following periodontal therapy
Simple Extractions – non-surgical removal of teeth Other oral surgery – dental surgery

Covered at 80% after deductible.

Deductible:  $50/person; $100/family per calendar year


Major Services

Relines and repairs – to bridges, implants and dentures

Major restorative services – crowns
TMD Treatment – treatment of the disorder of the temporomandibular joint including related films Prosthodontic services – bridges, implants and dentures

Covered at 50% after deductible.

Deductible:  $50/person; $100/family per calendar year

Orthodontic services – braces up to the age of 19

Covered at 50% after deductible.

Deductible:  $50/person; $100/family per calendar year


Your out-of-pocket expenses for dental care, including your deductible and co-insurance costs, are eligible for reimbursement through your Health Savings Account. (Or for those not electing the HSA, you may be reimbursed through a Flexible Spending Account or Health Reimbursement Account.)

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