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You can use the licensed dental care provider of your choice. This plan is intended as an option if you have dental coverages elsewhere (e.g., through a spouse who works for a non-State employer). This preventive care plan covers diagnostic exams, x-rays, and cleanings to the same extent as the State Dental Plan.

The State will cover the full premium cost of this plan 1 and, if you are enrolled, you will receive a $100В rebate in January 2.

You would be responsible for paying the dentist whatever he or she charges, and you may have to submit your own claims.ДЎ Except for those employees in certain bargaining units who are hired on or after 1/1/00 who have a regular work schedule of 40 hours or less per bi-weekly pay period (not permanent-intermittent positions). In this case, Delta Dental would pay you directly based on the dentistвЂ™s submitted fee or Delta DentalвЂ™s nonparticipating dentist fee, whichever is less. If you see a dentist who does not participate in either the Delta Dental PPO or Delta Dental PremierВ® network, you will still be covered, but you may have to pay more. If you choose to visit a Delta Dental PremierВ® provider, you will still receive the same protections and coverage as you would with a Delta Dental PPO provider, but it may cost more, as the Delta Dental PremierВ® providers accept a different fee schedule as payment in full. This is because providers who participate in the Delta Dental PPO network agree to accept the lowest fees as payment in full. The difference between the two networks is that you will receive greater savings when you receive care from a Delta Dental PPO network provider. While you can visit any provider, you will save the most money by visiting a dentist from one of two provider networks: Delta Dental PPO and Delta Dental PremierВ®. The State Dental Plan provides you the opportunity to see any provider you choose, regardless of whether that provider participates in Delta DentalвЂ™s networks. There is a separate lifetime maximum of $1,500 payable per member for orthodontics. This plan will pay a total of $1,500 in basic benefits per member each benefit year (October - September). These charges may be higher if you obtain services from a non-participating dentist. You are responsible for paying any remaining charges for these services.

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This plan covers preventive services (exams and cleanings) at 100% of the usual, customary, and reasonable charge radiographs (x-rays), oral surgery, extractions, restoratives, periodontics, and endodontics at 90% orthodontics at 60% and sealants for children and prosthodontics (including repairs) at 50%.

The State will cover 95% of the total premium 1, and you will pay the remaining 5% premium charge via payroll deductions.

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