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2024 Dental Benefits

Delta Dental
Dental Plan

You have the option to enroll in our group dental plan. The benefits and your contributions are as
follows:

You are strongly encouraged to use an Benefit In Network
in- network dentist to maximize your Annual Deductible $50 / $150
benefits and minimize your out-of- Individual/Family
pocket cost. To see if your dentist is in (waived for Preventive and
the network click on Provider Network Diagnostic services)
and select the DMHO network. Annual Maximum $1,000
Preventive Services Covered at 100%
•
Oral Exams
• Cleanings
Payment to non-network providers will • X-Rays
be based on the Network fee schedule, • Fluoride Treatment
and could result in balance billing. (through age 18)
Basic Services Include Covered 80% after deductible
• Fillings
•
Emergency Visits
Dental Care Plus Customer Service • Simple Denture Repair
800-367-9466 or 513-554-1100 • Basic Oral Surgery
• Simple Extractions
• Endodontic
• Periodontic
• Sealants
Major Services Include: Covered 50% after deductible
• Complex Extractions
• Crowns
• Inlays, Onlays
• Bridgework
• Complex / Partial Denture
Orthodontic Services Covered 50%
Limited to eligible dependents $1000 individual lifetime maximum
under 19 years if age

Coverage Election Monthly Salary EE’s Hourly EE’s
Employee Only $9.58 $4.42 $2.21
Employee + Spouse $18.38 $8.48 $4.24
Employee + Children $26.07 $12.03 $6.02
Family $35.19 $16.24 $8.12

For additional plan information, please refer to the detailed plan description provided by the carrier.
In the event of a discrepancy, the carrier Pan Document shall prevail.