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.

 

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