Administered by Delta Dental: 1-866-579-5717, www.deltadentalins.com/mus

Who is Eligible?

Retirees, legal spouse, and dependent children are eligible if you elect to have this coverage.

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 Summary Plan Description for fee schedule listing.

Maximum Annual Benefit $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

**The Preventive & Diagnostic Services listed above do not apply to the $2,000 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 will establish a monthly reimbursement based on your provider’s monthly fee and your prescribed treatment plan.