Like most dental plans, there are deductibles, co-payment, co-insurance, maximum out-of-pocket amounts, and limitations on benefits for pre-existing conditions.
Schedule of benefits
- $1,500 maximum benefits for Type A, B and C services for each covered person per calendar year. There is a $50 deductible for benefits received per person in Type B and C with a maximum of $100 per family, per calendar year. No deductible on Type A services.
Coverage A – Delta Dental’s coverage is 100%
- Routine periodic exams, twice in any calendar year.
- Routine dental prophylaxis twice in any calendar year. Including cleaning and polishing.
- Bitewing and periapical e-rays as required. Full mouth e-rays once in a three year period.
Coverage B – Delta Dental coverage is 80%
- Minor emergency treatment for relief of pain as needed by the participant.
- Filing including amalgam and composite restoration.
- Periodontics: non-surgical and surgical procedures necessary for the treatment of disease of gum and bone supporting the teeth.
- Endodontics, including pulpal therapy and root canal filling.
- Extractions, simple and surgical.
- Oral surgery, including pre- and post-operative cares.
- Stainless steel crowns used a restoration to natural teeth for dependent children to age 16, when the teeth cannot be restored with a filling material.
Coverage C – Delta Dental coverage is 50%
- Prosthetics: provided bridges, partial and dentures.
- Crown and jackets when the teeth cannot be restored with a filling material under coverage B.
This website provides a summary of the dental insurance plan and not an actual contract. For more information visit or call Department of Human Resources for specific details of the University’s dental insurance plan, including eligibility criteria, enrollment forms, plan benefits and exclusions, limitations, and a list of Participating Providers.