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
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-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
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)