Dental Plan



The Dental Benefit is administered by Delta Dental: 1-866-579-5717,

Retirees are offered enrollment in the Select Dental Plan only. If you do not make an election when you first retire, you will permanently forfeit your dental coverage eligibility.

Dental claims are reimbursed based on a fee schedule of benefits.The fee schedule dollar amount is the maximum reimbursement for the specified dental procedure code.

Covered individuals are responsible for the difference (if any) between the provider’s charge and the
fee schedule reimbursement amount. See the Choices Benefits Ernollment Workbook or the Summary Plan Description for listing.

Select Plan Coverage
Who May be Enrolled &
Monthly Rates
  • Retiree/Survivor Only $52
  • Retiree & Spouse $94
  • Retiree/Survivor & Child(ren) $94
  • Retiree & Family $156
Maximum Annual Benefit
$1,500 per covered individual
Preventive and Diagnostic Services
  • 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 $1,500 annual benefit maximum

Basic Restorative Services
  • Amalgam filling
  • Endodontic treatment
  • Periodontic treatment
  • Oral surgery
Major Dental Services
  • Crown
  • Root canal
  • Complete lower and upper denture
  • Dental implant
  • Occlusal guards
Removal of impacted teeth
  • Covered benefit

Orthodonitic 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 (our dental plan administrator) will establish a monthly reimbursement based on your provider’s monthly fee and your prescribed treatment plan.

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