Dental Benefits
Administered by Delta Dental
Good oral care enhances overall physical health , appearance and mental well-being . Problems with the teeth and gums are common and easily treated health problems . Keep your teeth healthy and your smile bright with the HRCentral dental benefit plan .
Benefit Plan Features Core Dental Buy Up Dental Network Options In-Network / Out-of-Network Delta Dental PPO
Calendar Year Benefits Maximum Applies to : Class I , II , III and IX Expenses
Calendar Year Deductible Individual Family
Delta Dental Premier or Out-of-Network
$ 2,000 $ 2,000 $ 2,000
$ 50 $ 150
$ 50 $ 150
$ 50 $ 150
Benefit Highlights Plan Pays Plan Pays Plan Pays
Class I : Diagnostic and Preventive Oral Evaluations Prophylaxis : Routine Cleanings X-Rays : Routine X-Rays : Non-Routine Fluoride Application Sealants : Per Tooth Space Maintainers : Non-Orthodontic Emergency Care To Relieve Pain
Class II : Basic Restorative Restorative : Fillings Endodontics : Minor and Major Periodontics : Minor and Major Oral Surgery : Minor and Major Anesthesia : General and IV Sedation
Class III : Major Restorative Inlays and Onlays Prosthesis Over Implant Crowns : Prefabricated Stainless Steel / Resin Crowns : Permanent Cast and Porcelain Bridges and Dentures Denture Relines , Rebases and Adjustments Repairs : Bridges , Crowns and Inlays Repairs : Dentures
Class IV : Orthodontia Coverage for Employee and All Dependents Lifetime Benefits Maximum : $ 1,500
Class IX : Implants
100 % No deductible
80 % After deductible
50 % After deductible
Not covered
50 % After deductible
100 % No deductible
80 % After deductible
50 % After deductible
50 % No deductible
50 % After deductible
80 % No deductible
70 % After deductible
40 % After deductible
50 % No deductible
40 % After deductible
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