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Good dental health is critical to your overall well-being. You may purchase dental insurance that is designed to prevent problems before they occur.

There is no deductible for the dental plan, and preventive and diagnostic services are paid at 100%. In addition, the plan pays 85% of therapeutic and restorative services. Major/complex services are paid at 60% and orthodontic services at 50% (with a lifetime limit of $1,500 on the base plan and $2,500 on the buy-up). Keep in mind, the plan has an annual maximum limit of $1,500 per person on the base plan and $2,000 on the buy-up. All payments are subject to reasonable and customary guidelines. Your dental plan can be purchased on a pre-tax basis using payroll deductions. Please see chart for additional coverage information.

For dental coverage, you may use any dentist you wish. However, your out-of-pocket expenses will be lower if you use a dentist who participates in one of the two Delta Dental of Ohio networks – Delta Dental PPO & Delta Dental Premier. If a member sees an out-of-network provider, they can be balance billed. In the event that treatment is rendered from a dentist that does not participate in any of Delta Dental’s programs, the patient may be responsible for more than the percentage indicated below.


Carrier: Delta Dental
Policy Number: 5933
Customer Service:

Services Base Plan Buy-Up Plan
Annual Maximum $1,500 per person $2,000 per person
Preventive Services
Two oral exams and cleanings per year; Bitewing X-ray once per calendar year; Full mouth X-ray once every 5 years.
100% Coverage 100% Coverage
Deductible No Deductible No Deductible
Basic Services
Oral surgery, root canals, general anesthesia, gingivitis surgery, specified endodontic procedures, periodontal, antibiotic injections, extractions, alveoplasty, routine fillings, filling restorations to diseased/broken teeth, and repair of crowns, inlays, onlays and dentures (with limitations).
85% Coverage 85% Coverage
Major Services
Inlays, onlays, gold fillings or crow n restorations to repair diseased or accidentally broken teeth (when tooth can not be restored with routine fillings); Initial installation of dentures, bridgework, replacement of bridge or dentures (with limitations); Mouth guards.
60% Coverage 60% Coverage
Braces and related treatments and procedures.

50% Coverage
(lifetime max $1,500)

50% Coverage
(lifetime max $2,500)

*Subject to reasonable and customary limitations.

Employee Payroll Contributions
  Basic Plan Buy-Up Plan
  Weekly Bi-Weekly  Weekly Bi-Weekly 
Employee $5.25 $10.50 $6.05 $12.09
Employee + Spouse $10.50 $21.00 $12.10 $24.19
Employee + Child(ren) $12.50 $25.00 $17.08 $34.15
Family $19.00 $38.00 $22.16 $44.32