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Retiree Dental Plan

In addition to coverage for basic dental and major dental services, Stanford's retiree dental plan covers diagnostic and preventive checkups as well as regular cleanings.

You must be enrolled in one of the retiree medical plans to be eligible for the retiree dental plan.

Plan Information

Our retiree dental coverage plan gives you the freedom to choose your own dentist, though your out-of-pocket costs will be lower if you see a dentist in Delta's PPO network.

Basics

 

Overview

This plan pays in-network benefits when your care is either provided or authorized by your Delta Dental PPO network dentist.

If your network dentist does not provide or authorize your care, the charges are considered out of network.

You are encouraged to obtain a predetermination of benefits from Delta for services greater than $300, or for crowns or bridges.

Delta Dental Group #1149

Co-insurance

Network:
- Preventive and diagnostic: 100% of the negotiated rate
- Basic procedures: 80% of the negotiated rate
- Major restorative procedures: 50% of the negotiated rate

Non-Network:
- All services: 50% of usual & customary charges

Deductible

Network: $0 per individual/$0 per family
Non-network: $50 per individual/$150 family

Annual Maximum

Network & Non-Network Combined: $1,000 per individual

No lifetime maximum.

Preventative Care

 

Cleanings

Preventive and Diagnostic service:
Network: 100%
Non-Network: 50% (deductible waived)

Fluoride treatments

Preventive and Diagnostic service:
Network: 100%
Non-Network: 50% (deductible waived)

Routine Exams

Preventive and Diagnostic service:
Network: 100%
Non-Network: 50% (deductible waived)

Sealants

Basic procedures service:
Network: 80%
Non-Network: 50% after deductible
X-rays Preventive and Diagnostic service:
Network: 100%
Non-Network: 50% (deductible waived)
Orthodontics Services  

Orthodontia

Not covered

Retainers

Not covered