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Retiree Dental Plan

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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 #01149

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

Non-PPO Network: Delta Dental Premier or non Delta Dental providers:
- All services: 50% of Premier dentist fee or program allowance
DeductibleNetwork: $0 per individual/$0 per family
Non-network: $50 per individual/$150 family
Annual Maximum

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

Diagnostic and Preventative services do not count towards annual maximum.

PREVENTATIVE CARE
CleaningsPreventive and Diagnostic service:
Network: 100%
Non-PPO Network: 50% (deductible waived) Plan allows up to 2 cleanings a year.
Fluoride treatmentsPreventive and Diagnostic service:
Network: 100%
Non-PPO Network: 50% (deductible waived)
Routine ExamsPreventive and Diagnostic service:
Network: 100%
Non-PPO Network: 50% (deductible waived)
Sealants for children to age 15Basic procedures service:
Network: 80%
Non-PPO Network: 50% after deductible
X-raysPreventive and Diagnostic service:
Network: 100%
Non-PPO Network: 50% (deductible waived)
ORTHODONTICS SERVICES
OrthodontiaNot covered
RetainersNot covered