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Human Resources

Dental Plan Comparison

Delta Premier is a great choice for employees who value access, flexibility and freedom of choice. Care is available from approximately 6,600 dentists (over 96 percent of practicing dentists in Massachusetts).

Delta Care II is a great choice for employees who value managed care and prevention. Employees choose a "primary care dentist" who directs and coordinates all primary and specialty care. Please note that the provider you choose is not guaranteed to stay in the plan during your enrollment, and therefore you may have to be flexible in choosing other providers.

 
  Delta Premier
(6,600 dentists)		 Delta Care II
(750 dentists)
Type I Services
Diagnostic 100 percent coverage co-payment schedule*
Preventive 100 percent coverage co-payment schedule*
Type II Services
Restorative 80 percent coverage co-payment schedule*
Oral Surgery 80 percent coverage There is a $1,000 per personal annual calendar year maximum
Periodontics 80 percent coverage There is a $1,000 per personal annual calendar year maximum
Endodontics 80 percent coverage There is a $1,000 per personal annual calendar year maximum
Prosthetic Maintenance 80 percent coverage co-payment schedule*
Emergency Dental Care 80 percent coverage co-payment schedule*
Type III Services
Major Restorative 50 percent coverage co-payment schedule*
Prosthodontics 50 percent coverage co-payment schedule*
Calendar Year Deductible (Type II and Type III Services)
  $100 per individual, $300 per family None
Calendar Year Maximum
  $1,000 per person $1,000 maximum applies to Oral Surgery, Endodontics and Periodontics
  Fourth Quarter Carry Forward Deductible.  
Orthodontia
  Not covered Benefits based upon 24 months of active treatment. Please refer to DeltaCare co-payment brochure.
Dependents are covered until age 26. Dependents are covered until age 26.

*All services must be provided by a Delta Care primary care dentist and are subject to the Delta Care Patient co-payment schedule available from Human Resources or on the Delta Dental website at http://www.deltamass.com. Limited out-of-network benefit, subject to a $100 per person deductible applicable to all services.
updated 03/21/12 | 02:50 PM
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