Dental Plan Availability & Comparison

Dental Plan Comparison

For all of the dental plans, the annual maximum is $1,800 in 2019 and $2,000 in 2020 for all benefits per person per contract year. You can find the detail of what is covered in each category below the chart.

Plan Diagnostic and
Preventive Care
Basic Restorative Care Major Restorative Care Emergency Services Orthodontics
DELTA DENTAL PREMIER
In-network
100% coverage 80% coverage 50% coverage Emergency dental services provided same as eligible dental services 80% coverage
DELTA DENTAL PREMIER
Out-of-network*
50% coverage After $125 annual deductible, 50% coverage No coverage After $125 annual deductible, emergency dental services provided same as eligible out-of-network services 50% coverage
DELTA DENTAL PPO
In-network coverage only
100% coverage 80% coverage 50% coverage In-network services provided same as any service; out-of-network services apply $50 deductible then same as any in-network service 80% coverage

*Out-of-network:

If you use an out-of-network provider, you will receive lower reimbursement amounts for services compared to the reimbursements you would receive from a Delta Dental In-network provider. It is strongly encouraged that your provider submit a pre-treatment estimate prior to services being received. This will prevent any surprise charges after treatment has been received. If you receive services from an out-of-network provider, you may need to:

  • Pay for services up-front
  • Pay more money for services than you would with an in-network dentist
  • File the dental claim form with Delta Dental
  • Receive reimbursements sent directly to you from Delta Dental

Learn more about in-network versus out-of-network costs on Delta Dental's cost example, Two Networks, More Choices (pdf). 

 

What is Covered Under Each Type of Service?

Diagnostic and Preventive Care

    • Oral examinations and dental cleanings
      • Two oral exams and cleanings per person per calendar year
      • X-rays
      • Special periodontics care
      • Topical fluoride to age 19
      • Space maintainers

Basic Restorative Care

      • Fillings (customary restorative materials)
        • Plan coverage on back teeth based on composite (white) fillings: Delta Dental Premier 
        • Plan coverage on back teeth based on amalgam (silver) fillings: Delta Dental PPO 
        • Plan coverage on front teeth based on composite (white) fillings: Both Plans
      • Sealants to age 19
      • Extractions and other oral surgery
      • Periodontics (gum disease therapy)
      • Endodontics (root canal therapy)
      • Restorative crowns
      • Inlays & onlays, repair of crown

Major Restorative Care

      • Fixed or removable bridgework
      • Implants as alternative treatment
      • Full or partial dentures
      • Denture relines or rebases

Orthodontics Coverage

      • Limited to dependents up to age 19
      • Separate $2,800 lifetime maximum per covered dependent that does not start over if you change plans

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Dental: Plan Availability

Yes: Plan is available
No: Not available
Base Plan: Base Plan for this county

County Delta Dental PPO Delta Dental Premier
Aitkin Yes Yes - Base Plan
Anoka Yes - Base Plan Yes
Becker Yes Yes - Base Plan
Beltrami Yes Yes - Base Plan
Benton Yes Yes - Base Plan
Big Stone No Yes - Base Plan
Blue Earth Yes Yes - Base Plan
Brown Yes Yes - Base Plan
Carlton* Yes - Base Plan Yes - Base Plan
Carver Yes - Base Plan Yes
Cass Yes Yes - Base Plan
Chippewa Yes Yes - Base Plan
Chisago Yes - Base Plan Yes
Clay Yes Yes - Base Plan
Clearwater Yes Yes - Base Plan
Cook No Yes - Base Plan
Cottonwood Yes Yes - Base Plan
Crow Wing Yes Yes - Base Plan
Dakota Yes - Base Plan Yes
Dodge No Yes - Base Plan
Douglas Yes Yes - Base Plan
Faribault Yes Yes - Base Plan
Fillmore Yes Yes - Base Plan
Freeborn Yes Yes - Base Plan
Goodhue Yes Yes - Base Plan
Grant No Yes - Base Plan
Hennepin Yes - Base Plan Yes
Houston Yes Yes - Base Plan
Hubbard Yes Yes - Base Plan
Isanti Yes - Base Plan Yes
Itasca Yes Yes - Base Plan
Jackson Yes Yes - Base Plan
Kanabec Yes - Base Plan Yes
Kandiyohi Yes Yes - Base Plan
Kittson Yes Yes - Base Plan
Koochiching Yes Yes - Base Plan
Lac Qui Parle Yes Yes - Base Plan
Lake Yes - Base Plan Yes
Lake of the Woods No Yes - Base Plan
Le Sueur Yes Yes - Base Plan
Lincoln No Yes - Base Plan
Lyon Yes Yes - Base Plan
Mahnomen Yes Yes - Base Plan
Marshall No Yes - Base Plan
Martin Yes Yes - Base Plan
McLeod Yes - Base Plan Yes
Meeker Yes Yes - Base Plan
Mille Lacs Yes Yes - Base Plan
Morrison Yes Yes - Base Plan
Mower Yes Yes - Base Plan
Murray No Yes - Base Plan
Nicollet Yes Yes - Base Plan
Nobles Yes Yes - Base Plan
Norman No Yes - Base Plan
Olmstead Yes Yes - Base Plan
Otter Tail Yes Yes - Base Plan
Pennington Yes Yes - Base Plan
Pine Yes Yes - Base Plan
Pipestone Yes Yes - Base Plan
Polk Yes Yes - Base Plan
Pope Yes Yes - Base Plan
Ramsey Yes - Base Plan Yes
Red Lake No Yes - Base Plan
Redwood Yes Yes - Base Plan
Renville Yes Yes - Base Plan
Rice Yes Yes - Base Plan
Rock Yes Yes - Base Plan
Roseau No Yes - Base Plan
Scott Yes - Base Plan Yes
Sherburne Yes - Base Plan Yes
Sibley Yes Yes - Base Plan
St. Louis Yes - Base Plan Yes
Stearns Yes Yes - Base Plan
Steele Yes Yes - Base Plan
Stevens Yes Yes - Base Plan
Swift No Yes - Base Plan
Todd Yes Yes - Base Plan
Traverse Yes Yes - Base Plan
Wabasha Yes Yes - Base Plan
Wadena Yes Yes - Base Plan
Waseca No Yes - Base Plan
Washington Yes - Base Plan Yes
Watonwan Yes Yes - Base Plan
Wilkin Yes Yes - Base Plan
Winona Yes Yes - Base Plan
Wright Yes - Base Plan Yes
Yellow Medicine Yes Yes - Base Plan

*Carlton Northern area: Delta Dental PPO. Carlton Southern area: Delta Dental Premier.

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