Voluntary Dental Plan for Students – Benefit Highlights

These highlights are a brief description of the new Delta Dental Student Plan.

Plan Maximum: $1,200/patient/contract year

Annual Deductible: $50 per person not to exceed $150 per family

In-Network:

Delta Dental will pay for a portion of eligible expenses. You pay the amount per the Plan’s Table of Copayments when treated by in-network dentists, Delta Dental pays the remainder of the discounted fees. The Plan’s national networks are:

  • the Delta Dental PPO and
  • the Delta Dental Premier network.

Exclusions and Limitations apply, refer to Schedule B in the Evidence of Coverage.

Out of Network:

Eligible dental expenses and services are listed below with the corresponding out of network co-insurance that Delta Dental will pay. Exclusions and Limitation apply, refer to Schedule B in the Evidence of Coverage.

  • Diagnostic and Preventive, 60%
  • Sealants, 40%
  • Space Maintainers, 60%
  • Basic Restorative, 40%
  • Oral Surgery, 40%
  • Simple Extractions, 40%
  • Endodontics, 40%
  • Surgical Periodontics, 40%
  • Non-Surgical Periodontics, 40%
  • Major Restorative, 25%
  • Prosthodontics-Fixed & removable, 25%
  • Denture Repair and Relining, 40%
  • Implants, 25%