Overview
Healthy teeth and gums are important to your overall wellness. To help you maintain your dental health and address any issues, your dental coverage from DSM pays for most preventive and diagnostic care and helps pay for the cost of basic and major restorative treatments. The High PPO Dental Plan also provides orthodontia benefits for you and your covered dependents.
Dental Plans:
- High PPO
- Low PPO
Key features at a glance:
Free in-network preventive and diagnostic care, with no deductible.
Affordable coverage
that helps you manage the cost of dental treatment.
Wide network of providers
that have agreed to negotiated rates, which helps you save money.
Support for Active Children
Coverage includes custom athletic mouth guards (one guard every two years through the age of 18), to help protect your child(ren)’s teeth.
Find a network dentist
You'll generally pay less out-of-pocket when you use an in-network dentist. Visit Delta Dental of North Carolina for more information.
Coverage Details
| High PPO | Low PPO | |
|---|---|---|
| In-network | ||
| Individual/family deductible | $50/$150 | $50/$150 |
| Services (the plan pays)** | ||
| Preventive & Diagnostic Care* | 100% (no deductible) | 100% (no deductible) |
| Basic | 80% after deductible | 80% after deductible |
| Major services | 60% after deductible | 50% after deductible |
| Annual maximum benefit (one person can receive for non-orthodontic services) | $2,000 | $1,500 |
| Orthodontia treatment (for children and adults) | 50% (no deductible) | Not covered |
| Orthodontia coinsurance/lifetime maximum per person* | $2,000 | Not covered |
*Does not count towards annual maximum.
**Extra cleanings and Perio-Maintenance treatments available for members with at-risk conditions. See the Resources page for a list of covered services.
Using your dental benefits
Here’s how to make the most of your dental benefits:
- Choose a provider. Each time you need dental care, you have a choice of providers. Selecting a Delta Dental of North Carolina participating dentist will ensure you receive the highest benefits from your plan. To find a provider, go to Delta Dental of North Carolina.
- Present your plan identification information at your provider’s office. Group #8118
- If your service will exceed $200, submit for a pre-treatment estimate. You should always submit a request for a pre-treatment estimate for procedures and services your dentist believes will exceed $200 (procedures such as crowns, inlays, bridges, and periodontics). For more information about pre-treatment estimates, call Delta Dental of North Carolina at 1-800-662-8856 or visit Delta Dental of North Carolina.
- Check your claim status and other information at Delta Dental of North Carolina. You can review Explanation of Benefits (EOB) statements, check if claims have been paid, and more.
Pay with your Health Care FSA
You can receive your Health Care FSA reimbursement for dental claims quickly and easily. If you are enrolled in the Delta Dental of North Carolina plan, your dental claims will be automatically sent to HealthEquity for review and approval of reimbursement to your FSA (both the Health Care FSA and the Limited FSA). If the claim is approved, you will receive reimbursement from HealthEquity.