Which individual and family plan is right for you?
No one has a smile like you. And no one can keep it healthy like us.
Traditional
$51
.00 Per Month / Single
Per Month / Single
Our most popular plan to keep smiles healthy has a low one-time deductible.
Diagnostic & Preventive Services
100%
Other Services
50%
Orthodontics
No
One Time Deductible
$50 per person
Annual Maximum
$1,200
Health through Oral Wellness
Yes
ACA Standard
$37
.50 Per Month / Single
Per Month / Single
Our lowest cost plan is ACA certified and includes a child-only option.
Diagnostic & Preventive Services
100%
Other Servcies
40% - 60%
Orthodontics
Medical Necessity
Annual Deductible
$100 per person
Annual Maximum
$1,000
Health through Oral Wellness
Yes
ACA Enhanced
$51
.70 Per Month / Single
Per Month / Single
No deductible and a higher annual maximum benefit ACA certified plan.
Diagnostic & Preventive Services
100%
Other Services
40% - 60%
Orthodontics
Medical Necessity
Deductible
None
Annual Maximum
$1,500
Health through Oral Wellness
Yes
Traditional Plan [1040]
Traditional Plan
Network: PPO Plus Premier
Traditional Plan
Monthly Rate: Single
$51.00
Monthly Rate: Couple/Two Person
$102.00
Monthly Rate: Family
$150.90
Diagnostic & Preventive Services
Check-ups & routine teeth cleaning
100%
Routine & Restorative Services
Cavity repair, fillings
50%
Extractions & Oral Surgery
Including wisdom teeth
50%
Endodontics & Periodontics
Root canals, gum & bone diseases - 1 year wait for coverage
50%
Major 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
Prevention Pays
| Traditional Plan | $51.00 |
| Traditional Plan | $102.00 |
| Traditional Plan | $150.90 |
Check-ups & routine teeth cleaning
| Traditional Plan | 100% |
Cavity repair, fillings
| Traditional Plan | 50% |
Including wisdom teeth
| Traditional Plan | 50% |
Root canals, gum & bone diseases - 1 year wait for coverage
| Traditional Plan | 50% |
Crowns, bridges, dentures, implants - 1 year wait for coverage
| Traditional Plan | 50% |
Braces
| Traditional Plan | None |
Added benefits if you're at high risk of tooth decay or gum disease
| Traditional Plan | Yes |
Covers diagnostic and preventive care beyond annual maximum benefit
| Traditional Plan | Yes |
One time per person
| Traditional Plan | $50 |
Per person per calendar year
| Traditional Plan | $1,200 |
| Traditional Plan |
ACA Standard [502]
ACA Standard Plan
Network: PPO Plus Premier
Standard Plan
Monthly Rate: Single Adult or Child Only
$37.50
Monthly Rate: Couple/Two Person
Can be Member + 1 dependent
$75.00
Monthly Rate: Member + 2 dependents
$112.50
Monthly Rate: Member + 3 or more dependents
$150.00
Monthly Rate: Couple + 1 dependent
$112.50
Monthly Rate: Couple + 2 dependents
$150.00
Monthly Rate: Couple + 3 or more dependents
$187.50
Diagnostic & Preventive Services
Check-ups & routine teeth cleaning
100%
Routine & Restorative Services
Cavity repair, fillings
60%
Extractions & Oral Surgery
1 year wait for coverage for age 19 or older
40%
Wisdom Teeth Extraction
Medical necessity only
40% - only in rare circumstance as determined by a third party dental consultant, and requires preauthorization
Endodontics & Periodontics
Root canals, gum & bone diseases - 1 year wait for coverage ages 19+
40%
Major Services
Crowns, bridges, dentures, implants - 1 year wait for coverage for ages 19+
40%
Orthodontics
Braces
40% - only for children under age 19 and only in rare circumstance as determined by a third party dental consultant, and requires preauthorization
Health through Oral Wellness
Added benefits for those at high risk of tooth decay or gum disease
Yes
Prevention Pays
Covers diagnostic and preventive care beyond annual maximum benefit
Yes
Deductible
Per person per year
$100
Annual Maximum Benefit
For age 19 and older
$1,000
Annual Out-of-Pocket Maximum
For children under age 19
$350 per child / $700 for two or more children
Dependents
Covered to age 26
| Standard Plan | $37.50 |
Can be Member + 1 dependent
| Standard Plan | $75.00 |
| Standard Plan | $112.50 |
| Standard Plan | $150.00 |
| Standard Plan | $112.50 |
| Standard Plan | $150.00 |
| Standard Plan | $187.50 |
Check-ups & routine teeth cleaning
| Standard Plan | 100% |
Cavity repair, fillings
| Standard Plan | 60% |
1 year wait for coverage for age 19 or older
| Standard Plan | 40% |
Medical necessity only
Root canals, gum & bone diseases - 1 year wait for coverage ages 19+
| Standard Plan | 40% |
Crowns, bridges, dentures, implants - 1 year wait for coverage for ages 19+
| Standard Plan | 40% |
Braces
Added benefits for those at high risk of tooth decay or gum disease
| Standard Plan | Yes |
Covers diagnostic and preventive care beyond annual maximum benefit
| Standard Plan | Yes |
Per person per year
| Standard Plan | $100 |
For age 19 and older
| Standard Plan | $1,000 |
For children under age 19
ACA Enhanced [503]
ACA Enhanced Plan
Network: PPO Plus Premier
Enhanced Plan
Monthly Rate: Single Adult or Child Only
$51.70
Monthly Rate: Couple/Two Person
Can be Member + 1 dependent
$103.40
Monthly Rate: Member + 2 dependents
$155.10
Monthly Rate: Member + 3 or more dependents
$206.80
Monthly Rate: Couple + 1 dependent
$155.10
Monthly Rate: Couple + 2 dependents
$206.80
Monthly Rate: Couple + 3 or more dependents
$258.50
Diagnostic & Preventive Services
Check-ups & routine teeth cleaning
100%
Routine & Restorative Services
Cavity repair, fillings
60%
Extractions & Oral Surgery
1 year wait for coverage for age 19 or older
40%
Wisdom Teeth Extraction
Medical necessity only
40% - only in rare circumstance as determined by a third party dental consultant, and requires preauthorization
Endodontics & Periodontics
Root canals, gum & bone diseases - 1 year wait for coverage ages 19+
40%
Major Services
Crowns, bridges, dentures, implants - 1 year wait for coverage for ages 19+
40%
Orthodontics
Braces
40% - only for children under age 19 and only in rare circumstance as determined by a third party dental consultant, and requires preauthorization
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
None
Annual Maximum Benefit
For age 19 and older
$1,500
Annual Out-of-Pocket Maximum
For children under age 19
$350 per child / $700 for two or more children
Dependents
Covered to age 26
| Enhanced Plan | $51.70 |
Can be Member + 1 dependent
| Enhanced Plan | $103.40 |
| Enhanced Plan | $155.10 |
| Enhanced Plan | $206.80 |
| Enhanced Plan | $155.10 |
| Enhanced Plan | $206.80 |
| Enhanced Plan | $258.50 |
Check-ups & routine teeth cleaning
| Enhanced Plan | 100% |
Cavity repair, fillings
| Enhanced Plan | 60% |
1 year wait for coverage for age 19 or older
| Enhanced Plan | 40% |
Medical necessity only
Root canals, gum & bone diseases - 1 year wait for coverage ages 19+
| Enhanced Plan | 40% |
Crowns, bridges, dentures, implants - 1 year wait for coverage for ages 19+
| Enhanced Plan | 40% |
Braces
Added benefits if you're at high risk of tooth decay or gum disease
Covers diagnostic and preventive care beyond annual maximum benefit
| Enhanced Plan | Yes |
For age 19 and older
| Enhanced Plan | $1,500 |
For children under age 19
Health through Oral Wellness
Our individual and family plans include 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.
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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
Individual and family plans are Delta Dental PPO Plus Premier plans. 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 Plans with our Frequently Asked Questions page.
Plan exclusions
Some things aren't covered by our Individual & Family Plans. See what they are on our Plan Exclusions page.
Plan documents
Download plan summaries, enrollment forms, and other files at our Document Library.
