How It Works
You can receive care from any licensed dental provider, but you maximize your benefits — and save money — when you see an in-network Moda Premier and PPO dental provider.
If you choose to see an out-of-network dentist, you will be responsible for paying the additional costs if the provider’s charges exceed the maximum plan allowance (MPA).
All regular full-time employees are eligible to enroll in dental coverage. You can also cover your eligible dependents. If you enroll in the dental plan, you will also be enrolled in the vision plan. Coverage begins on the first day of the month following your hire date.
Here’s a quick look at the dental plan. For details, review the Delta Dental Premier Plan Booklet.
|Annual Benefit Maximum||$2,000||$2,000|
|COVERED SERVICES||What You Pay|
|Diagnostic and Preventive Services
Periodic Exams, X-rays, Cleanings, Brush Biopsy and Lab, Sealants, Space Maintainers, Topical Fluoride Application
|$0; no deductible||$0; no deductible|
Restorative Fillings, Oral Surgery, Endodontic Treatments, Periodontic Treatments
|20% after deductible||20% MPA after deductible|
Crowns, Cast Restorations, Denture and Bridge Work
|40% after deductible||40% MPA after deductible|
Adults and Dependent Children
|Lifetime Orthodontia Plan Maximum
Not included in the Annual Benefit Maximum
Maximum Plan Allowance
The maximum amount Moda Health will reimburse dentists and other providers.
Eligible dependents include your spouse/domestic partner, as defined by state law, your biological and stepchildren, up to age 26 (unless disabled and approved to be covered on the plan as an adult dependent), and your legally adopted children and children placed with you in the process of adoption.