Delta Dental is State Industrial Products’ dental insurance provider. You may choose between two dental PPO plans – the Standard plan and the Value Plan. If you have any questions regarding the dental plan or want to find a network provider, visit Delta Dental at deltadentaloh.com or call 1-800-524-0149.
Things to Consider about the Dental Plan
When you need dental care, you can go to any provider you choose. However, using network providers can save you money in two ways:
- Participating network providers agree to accept Delta Dental’s fee based on their agreement with Delta Dental, which is typically lower than a provider that does not participate in a Delta Dental Network
- Under the Standard PPO Dental Plan, you do not have to pay any amount above Delta Dental’s allowed fee when you receive care from a provider that participates in one of Delta Dental’s networks. If you see a dentist in the Premier network, you will pay the difference between the PPO allowed amount and the Premier allowed amount.
Standard PPO Benefits
The Standard plan offers coverage for Preventive, Basic, Major and child orthodontia and provides benefits for services received from a dentist in the Delta PPO and Premier networks, or if you see a non-network dentist.
Resources
| Annual Deductible: $50/$150 Annual Benefit Maximum: $1,000 Lifetime Ortho Max: $1,500 |
Delta Dental PPO Dentist Plan Pays |
Delta Dental Premier Dentist Plan Pays |
Nonparticipating Dentist Plan Pays |
| Diagnostic & Preventative | |||
| Diagnostic and Preventative Services – exams, cleanings, fluoride, and space maintainers | 100% | 0% | 0% |
| Emergency Palliative Treatment – to temporarily relive pain | 100% | 0% | 0% |
| Sealants – to prevent decay of permanent teeth | 100% | 0% | 0% |
| Brush Biopsy – to detect oral cancer | 100% | 0% | 0% |
| Radiographs – X-rays | 100% | 0% | 0% |
| Periodontal Maintenance – cleanings following periodontal therapy | 100% | 0% | 0% |
| Basic Services | |||
| Minor Restorative Services – Fillings and crown repair | 80% | 0% | 0% |
| Endodontic Services – root canals | 80% | 0% | 0% |
| Periodontic Services – to treat gum disease | 80% | 0% | 0% |
| Oral Surgery Services – extractions and dental surgery | 80% | 0% | 0% |
| Other Basic Services – misc. services | 80% | 0% | 0% |
| Relines and Repairs – to prosthetic appliances | 80% | 0% | 0% |
| Major Services | |||
| Major Restorative Services – crowns | 60% | 40% | 40% |
| Prosthodontic Services – bridges, implants, dentures, and crowns over implants | 60% | 40% | 40% |
| Orthodontic Services | |||
| Orthodontic Services – braces | 50% | 40% | 40% |
| Orthodontic Age Limit | up to age 19 | up to age 19 | up to age 19 |
Dental Monthly Contributions
| Employee Only | Employee + 1 Dependent | Employee + Two or More Dependents |
| $42.00 | $84.00 | $126.00 |
Value PPO Benefits
The Value Plan offers coverage for Preventive and Basic services only and you must use a Delta PPO designated dentist.
| Annual Deductible: $50/$150 Annual Benefit Maximum: $1,000 |
Delta Dental PPO Dentist Plan Pays |
Delta Dental Premier Dentist Plan Pays |
Nonparticipating Dentist Plan Pays |
| Diagnostic & Preventative | |||
| Diagnostic and Preventative Services – exams, cleanings, fluoride, and space maintainers | 100% | 0% | 0% |
| Emergency Palliative Treatment – to temporarily relive pain | 100% | 0% | 0% |
| Sealants – to prevent decay of permanent teeth | 100% | 0% | 0% |
| Brush Biopsy – to detect oral cancer | 100% | 0% | 0% |
| Radiographs – X-rays | 100% | 0% | 0% |
| Periodontal Maintenance – cleanings following periodontal therapy | 100% | 0% | 0% |
| Basic Services | |||
| Minor Restorative Services – Fillings and crown repair | 80% | 0% | 0% |
| Endodontic Services – root canals | 80% | 0% | 0% |
| Periodontic Services – to treat gum disease | 80% | 0% | 0% |
| Oral Surgery Services – extractions and dental surgery | 80% | 0% | 0% |
| Other Basic Services – misc. services | 80% | 0% | 0% |
| Relines and Repairs – to prosthetic appliances | 80% | 0% | 0% |
Dental Monthly Contributions
| Employee Only | Employee + 1 Dependent | Employee + Two or More Dependents |
| $25.00 | $50.00 | $75.00 |
Finding a Dentist
You already have great dental benefits – do you have a great dentist, too? Having a dentist and dental office that you trust and can easily share concerns with make it more likely you’ll stay on top of those regular dental cleanings. Ask friends or family for recommendations, or use Delta Dental’s Find a Dentist tool at www.deltadentaloh.com/findadentist to look for options in your area.
