Health Care & Benefits Division

Dental Plan

Delta Dental is the State Plan’s Dental Plan third party administrator and processes dental claims for the State Plan. Dental coverage is an option benefit. 

 

Eligibility 

Employees, Legislators, Retirees, COBRA participants, and eligible spouse/domestic partners and child(ren). For detailed information on who’s eligible for the State Plan, please refer to the Wrap Plan Document.

 

ONline Account

By creating an account at deltadentalins.com/stateofmontana, you can manage your dental benefits easily, from wherever you are. With an online account, you can view and print your member ID card, find an in-network dentist, check your plan details and eligibility, browse claim history, and more. Click for instructions on setting up your account.

 

coverage

 Deductible*

$50 Per Enrollee per Calendar Year

$150 Per family per Calendar Year

 Maximum Amount Plan Pays Per Member 

 $1,800 per Member per Calendar Year

 $1,500 Lifetime for Implant Benefits 

 Waiting Periods    

 None for Basic, Major, or Prosthodontics services

*Diagnostic & Preventive Benefits are not subject to the deductible.

Deductibles and maximums will be based upon a Plan Year, which is January 1 through December 31.

 

dental networks

To find an in-network dentist, go to deltadentalins.com/stateofmontana and login to your account. 

PPO and Premier Dentists agree to accept the the Delta Dental Allowance. You will only be responsible for your deductible and coinsurance amounts up to the maximum payable amount when using a PPO and Premier Dentist. An Out-of Network Dentist can bill you your deductible and coinsurance amounts, plus any amount over the Delta Dental allowance. Keep in mind you are responsible for any amount over the $1800 maximum payable amount regardless of provider network status. 

Preferred Provider (PPO Dentist) 
You usually pay the least when you visit a PPO Dentist because they agree to Delta’s lowest contracted fees.

Premier Dentist 
Premier Dentists have slightly higher contracted fees than PPO Dentists. You may end up paying more out-of-pocket at a Premier Dentist

Non-Network Dentist
If you see a Non-Network Dentist, you will be responsible for the difference between the allowable charge set by Delta Dental and what that dentist bills.

 

Benefits and Covered Services  

Benefit Coverage

 Diagnostic & Preventive Services (D&P)

 Exams, Cleanings, X-Rays, Sealants

100%

 Basic Benefits*

 Fillings, Posterior Composites

80%

 Endodontics* (Root Canals)

 Covered Under Basic Services 

80%

 Periodontics* (Gum Treatment)

 Covered Under Basic Services

80%

 Oral Surgery*

 Covered Under Basic Services

80%

 Major Benefits*

 Crowns, Inlays, Onlays, Cast Restorations

50%

 Prosthodontics*

 Bridges, Dentures, Implants

50%

 Implant Maximums

$1,500 Lifetime
*Subject to $50 individual / $150 family deductible

 

 

Resources

  

Delta Dental Logo

Phone: (866) 496-2370

Mailing Address:

1130 Sanctuary Parkway
Suite 600
Alpharetta, GA 30009

Claims Mailing Address:
PO Box 1809

Alpharetta, GA 30023-1809

Website: deltadentalins.com/stateofmontana

App: Delta Dental Mobile App

Group Number: 15855

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