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.
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.
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.
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.
To find an in-network dentist, go to deltadentalins.com/stateofmontana and login to your account.
You can visit any licensed dentist and receive coverage under the State Plan, but you will usually get the most value from your State Plan benefit when you choose a PPO or Premier Dentist. PPO and Premier Dentists agree to accept 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)
Have agreed to the lowest contracted fees. Your annual maximum dollars go further and you won't be balanced billed.
Premier Dentist
Have agreed to reduced contracted fees (not as low as PPO). Still provides dental insurance benefit, although you may end up paying more out-of-pocket. You won't be balance billed.
Non-Network Dentist
There's no contracted fee agreement, so your dentist can charge any amount. You still receive State Plan benefits, but using a non-network dentist can result in you reaching your annual maximum sooner and potentially being balanced billed..
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 |
Phone: (866) 496-2370
1130 Sanctuary Parkway
Suite 600
Alpharetta, GA 30009
Alpharetta, GA 30023-1809
Website: deltadentalins.com/stateofmontana
App: Delta Dental Mobile App
Group Number: 15855