Administered by Delta Dental, 1-866-579-5717

Who is Eligible?

Benefits eligible employees, COBRA enrollees, and their eligible dependents.

Benefits eligible employees enrolling in the Choices Medical Plan must elect a Dental Plan (Basic Plan or Select Plan).  Note: the Basic Plan provides coverage for a limited range of services including diagnostic and preventive services. 

During annual enrollment, benefits eligible employees may change their Dental Plan option and add eligible depenent childred to the Dental Plan.  Important Note:  Annual enrollment for the Plan year is Closed Enrollment for a legal spouse for Dental coverage unless there is a qualifying event.

Dental claims are reimbursed based on a fee schedule.  The fee schedule dollar amount is the maximum reimbursement for the specified dental procedure code.  Dental Plan enrollees are responsible for the difference (if any) between the provider's charge and the fee schedule reimbursement amount.  Reger to the Summary Plan Description (SPD) on the Choices home page for complete Dental Plan benefits, Plan exclusions, and fee schedule information.  

 
Basic Plan Coverage

Select Plan Coverage
Annual Benefit Maximum $750 per covered individual $2,000 per covered individual
Preventive and Diagnostic Services
  • Twice Per Benefit Year
  • Initial and Periodic oral exam
  • Cleaning
  • Complete series of intraoral X-rays
  • Twice Per Benefit Year
  • Initial and Periodic oral exam
  • Cleaning
  • Complete series of intraoral X-rays

**The Preventive & Diagnostic Services listed above do not apply to the $2,000 annual benefit maximum

Basic Restorative Services
  • Not covered
  • Amalgam filling
  • Endodontic treatment
  • Periodontic treatment
  • Oral surgery
  • Removal of impacted teeth
Major Dental Services
  • Not covered
  • Crown
  • Root canal
  • Complete lower and upper denture
  • Dental implant
  • Occlusal guards

 

Orthodontic Benefit
The Select Plan provides a $1,500 lifetime orthodontic benefit per covered individual. Benefits are paid at 50% of the allowed amount for authorized services. Treatment plans usually include an initial down payment and ongoing monthly fees. If an initial down payment is required, Choices will pay up to 50% of the initial payment, up to 1/3 of the total treatment charge. In addition, Delta Dental (Dental Plan Administrator) will establish a monthly reimbursement based on the provider’s monthly fee and the prescribed treatment plan.