Comprehensive Coverage, Family-Friendly Rates!
With Delta Dental's Individual and Family Plan, you save on dental services like routine cleanings, fillings, crowns, X-rays and much more. Enroll today or call 602.588.3624, option 2!
Individual & Family Dental Benefit Summary
| Monthly Premium Rates | Green | Blue | Purple | Orange | Yellow |
| Individual Only | $44.32 | $41.72 | $30.53 | $25.20 | $18.71 |
| Individual + 1 Dependent | $81.99 | $77.18 | $56.48 | $46.62 | $34.61 |
| Individual + 2 or More Dependents | $125.43 | $118.07 | $86.40 | $71.32 | $60.81 |
|
Annual Maximum
(benefit year) |
$2000 |
$1500 |
$1000 |
$1000 |
$500 |
|
Deductible
(benefit year)
(per person, applies to all services) |
$50 |
$50 |
$75 |
$100 |
$25 |
|
| Type 1 Preventative Services |
100% |
100% |
90% |
70% |
100% |
Exams (limited to 2 per person in benefit year)
Cleanings (limited to 2 per person in a benefit year)
Fluoride Treatments (limited to 1 per person in a benefit period, under age 16)
Space Maintainers (under age 14)
Sealants (under age 15) |
|
|
|
|
Fluoride to age 18;
Sealants to age 19;
Space Maintainers are not covered
|
|
| Type 2 Basic Services |
50% |
50% |
50% |
50% |
100% |
Bitewing X–rays (limited to 1 set per
person in a benefit year)
X–rays (full mouth/ panoramic – limited to
1 per person in 60 months)
Simple Extractions (Not covered on Yellow Plan)
Fillings (Not covered on Yellow Plan) |
|
|
|
|
Extractions and fillings are not covered on the Yellow Plan. |
|
| Type 3A Major Services - 12 month waiting
period* |
50% |
50% |
40% |
30% |
Not Covered |
Gum Disease Treatment
Root Canals
Surgical
Extractions
General Anesthesia
Denture Relines and Rebases,
Adjustments
Repairs to Crowns, Dentures and Bridges |
|
|
|
|
|
|
| Type 3B Major Services – 24 month
waiting period* |
50% |
50% |
40% |
30% |
Not Covered |
Special Restorative
Crowns
Complete
and partial dentures
Fixed Bridgework |
|
|
|
|
|
|
| Monthly Premium |
|
|
|
|
|
| Individual Only | $44.32 | $41.72 | $30.53 | $25.20 | $18.71 |
| Individual + 1 Dependent | $81.99 | $77.18 | $56.48 | $46.62 | $34.61 |
| Individual + 2 or More Dependents | $125.43 | $118.07 | $86.40 | $71.32 | $60.81 |
*If within the past 60 days you have been covered under a Delta Dental group plan, and had at least 12 months of continuous coverage under that plan, waiting periods may be waived. |
Details and Limitations
Individual Plan enrollment is for consecutive 12-month period(s). Enroll by the 21st day of the month and coverage will begin by the 1st day of the following month. Please refer to the terms and conditions for enrollment details and the cancellation policy.
If, within the past 60 days, you have been covered under a Delta Dental group plan and had at least 12 months of continuous coverage under that plan, waiting periods may be waived.
Dentists, employees and dependents of dental offices do not qualify for this plan.
For additional benefit information and limitations, please refer to the appropriate benefit booklet:
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