Dental Coverage

Good dental care improves your overall health. Our dental plan, administered through Delta Dental with a nationwide network, is designed to help you maintain a healthy smile through regular preventive care, and to fix any problems as soon as they occur. Because preventive care is so important, your dental plan covers these services in full - no deductible or copay. Benefits are paid in accordance with the benefits outline below. Please see plan certificate for complete benefit details. For dental rates, click here.

Type of Service	Base Plan	Buy-Up Plan
Dental Network	Nationwide Delta Dental Network	Nationwide Delta Dental Network
Annual Dental Maximum per Person	$1,000	$2,000
Calendar Year Deductible Single Family	$50 $150	$50 $150
Preventive Services Oral Exams & Cleanings Bitewing X-rays Panoramic X-ray (1 every 36 months) Fluoride Treatments (to age 12), Sealants (children up to age 14) Space Maintainer (to age 15)	100%; No deductible	100%; No deductible
Basic Services Fillings Endodontic Periodontal Relines, Repairs, and Adjustment to Dentures Simple and Surgical Extractions General Anesthesia	50% after deductible	80% after deductible
Major Services Major Restorative Services, Inlays, On lays, Crowns, Bridges Dentures	50% after deductible Dental Implants Excluded	50% after deductible Dental Implants Covered
Orthodontia for Children to Age 19 Coinsurance Lifetime Max per Individual	50% $1,000	50% $2,000

*This is a partial listing of benefits and services only. All covered services are subject to the conditions, limitations, exclusions, terms, and provisions of the Dental Certificate.

Your Delta Dental plan allows you to visit any dentist you like. You will maximize the value of your dental plan and minimize out-of-pocket costs by choosing a dentist who participates in one of Delta Dental’s two networks: Delta Dental PPO and Delta Dental Premier®. You’ll likely save the most money and receive the highest levels of coverage when you visit a Delta Dental PPO dentist. If you visit a dentist who does not participate in Delta Dental PPO, you can still save money if that dentist participates in Delta Dental Premier.

To find a Delta Dental participating dentist visit: deltadentalin.com/findadentist.

Seeing an out-of-network dentist? Click here.

Need help finding your ID card? Click here.

Vision Coverage

Vision care is another important part of your family's healthcare. As such, we offer vision services through EyeMed. The EyeMed network brings you an extensive network of vision care providers who offer copayments and/or allowances for eye exams, lenses, and frames. Every 12 months, the plan will cover your choice of either medically necessary contact lenses or eyeglass lenses. Find vision providers at eyemed.com & choose the SELECT network. For vision rates, click here.

Type of Service	In-Network
Vision Exam One exam every 12 months	$10 copay
Vision Materials	$25 copay
Frames $130 allowance for a wide selection of frames 20% off amount over your allowance One set of frames every 24 months	Material copay applies
Lenses Single vision, Bifocal, and Trifocal lined lenses One set of Lenses every 12 months	Material copay applies
Lens Upgrade UV Treatment, Tints, Scratch Coating, Polarization Polycarbonate Lens Anti-Reflective Coating Progressive Standard Lenses	$15 copay $15 copay 20% off Retail cost $40 copay $45 copay $90 copay
Contact Lenses Conventional ($130 allowance) Disposable ($130 allowance) Medically Necessary (paid in full) Once per 12 months	Material copay applies

*This is a partial listing of benefits and services only. All covered services are subject to the conditions, limitations, exclusions, terms, and provisions of the Vision Certificate.

Money-saving tip: You can use your HSA dollars for qualified out-of-pocket dental and vision expenses!

Health Savings Account Information

Continue to Why Consider a HDHP?