Retiree Dental Plan
Delta Dental Retiree PPO Plan EOC
Guidelines, Policies & Forms
Delta Dental Group #1149
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Active employees and official retirees can use this tool to compare medical benefits, as well as plan costs.
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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. Please keep in mind that when you retire mid year and move from a Stanford employee dental plan to the Stanford retiree plan, all services received under the employee plan will be applied to the retiree plan for the remainder of the calendar year. Benefits will reset at the start of the new calendar year.
BASICS | |
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Overview | This plan pays in-network benefits when your care is either provided or authorized by your Delta Dental PPO network dentist. Delta Dental Group #01149 |
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-PPO Network: Delta Dental Premier or non Delta Dental providers: - All services: 50% of Premier dentist fee or program allowance |
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 Diagnostic and Preventative services do not count towards annual maximum. |
PREVENTATIVE CARE | |
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Cleanings | Preventive and Diagnostic service: Network: 100% Non-PPO Network: 50% (deductible waived) Plan allows up to 2 cleanings a year. Additional cleanings may be available through the SmileWay program. |
Fluoride treatments | Preventive and Diagnostic service: Network: 100% Non-PPO Network: 50% (deductible waived) |
Routine Exams | Preventive and Diagnostic service: Network: 100% Non-PPO Network: 50% (deductible waived) |
Sealants for children to age 15 | Basic procedures service: Network: 80% Non-PPO Network: 50% after deductible |
X-rays | Preventive and Diagnostic service: Network: 100% Non-PPO Network: 50% (deductible waived) |
ORTHODONTICS SERVICES | |
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Orthodontia | Not covered |
Retainers | Not covered |