Individual and Family Plan

No one has a smile like you. And no one can keep it healthy like us.

Traditional

$56

.00 Per Month / Single

Per Month / Single

Including our best preventive care features to keep you healthy!

Diagnostic & Preventive Services

100%

Other Services

50%

Orthodontics

No

One-time Deductible

$50 per person

Annual Maximum

$1,200

Health through Oral Wellness

Yes

Prevention Pays

Yes

Individual & Family Plan (2023)

Traditional Plan [1040]

Network: PPO Plus Premier

Traditional Plan

Monthly Rate: Single

$56.00

Monthly Rate: Couple/Two Person

$112.00

Monthly Rate: Family

$165.80

Diagnostic & Preventive Services

Routine exams, cleanings, x-rays and more!

100%

Fillings

Cavity repair

50%

Extractions & Oral Surgery

Including wisdom teeth

50%

Endodontics & Periodontics

Root canals, gum disease treatment, periodontal maintenance cleanings - 1 year wait for coverage

50%

Major Restorative Services

Crowns, bridges, dentures, implants - 1 year wait for coverage

50%

Orthodontics

Braces

None

Health through Oral Wellness

Added benefits if you're at high risk of tooth decay or gum disease

Yes

Prevention Pays

Covers diagnostic and preventive care beyond annual maximum benefit

Yes

Deductible

One time per person

$50

Annual Maximum Benefit

Per person per calendar year

$1,200

Dependents

Covered to age 19 or full-time unmarried student

Monthly Rate: Single

Traditional Plan $56.00
Monthly Rate: Couple/Two Person

Traditional Plan $112.00
Monthly Rate: Family

Traditional Plan $165.80
Diagnostic & Preventive Services

Routine exams, cleanings, x-rays and more!

Traditional Plan 100%
Fillings

Cavity repair

Traditional Plan 50%
Extractions & Oral Surgery

Including wisdom teeth

Traditional Plan 50%
Endodontics & Periodontics

Root canals, gum disease treatment, periodontal maintenance cleanings - 1 year wait for coverage

Traditional Plan 50%
Major Restorative Services

Crowns, bridges, dentures, implants - 1 year wait for coverage

Traditional Plan 50%
Orthodontics

Braces

Traditional Plan None
Health through Oral Wellness

Added benefits if you're at high risk of tooth decay or gum disease

Traditional Plan Yes
Prevention Pays

Covers diagnostic and preventive care beyond annual maximum benefit

Traditional Plan Yes
Deductible

One time per person

Traditional Plan $50
Annual Maximum Benefit

Per person per calendar year

Traditional Plan $1,200
Dependents

Health through Oral Wellness

Our individual and family plan includes our innovative program that adds benefits based on each person's oral health needs. It's a patient-centered way to encourage better oral and overall health through preventive care.

Prevention Pays

Your dental plan does even more with Prevention Pays. Covering preventive care beyond the annual maximum benefit encourages regular dental visits to protect your smile and keep it healthy.

PPO Plus Premier

Our Individual and family plan features our Delta Dental PPO Plus Premier network. Enrolled members get a broad choice of dentists in two networks and lower out-of-pocket costs.

Paper enrollment form

Prefer a paper form instead? Use this .PDF file of our Individual/Family Plan enrollment form.

Frequent questions

Learn more about our Individual & Family Plan with our Frequently Asked Questions page.

Plan exclusions

Some things aren't covered by our Individual & Family Plan. See what they are on our Plan Exclusions page.

Plan documents

Download plan summaries, enrollment forms, and other files at our Document Library.