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 Option Dental PPO Plan also provides orthodontia benefits for you and your covered dependents.

2019 Dental Plans:

  • High Option PPO
  • Low Option 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.
icon 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 Option PPO Low Option 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 under age 19) 50% after 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.
Action
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 WageWorks 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 WageWorks.