Dental Coverage
Your oral health is closely connected to your overall wellbeing. That’s why we’ve coordinated with Delta Dental of Colorado to offer dental plans designed to support you.
Dental Coverage
Your oral health is closely connected to your overall wellbeing. That’s why we’ve coordinated with Delta Dental of Colorado to offer dental plans designed to support you.
Dental Coverage
Your oral health is closely connected to your overall wellbeing. That’s why we’ve coordinated with Delta Dental of Colorado to offer dental plans designed to support you.
Dental Highlights
Preventive PPO
Delta Dental of Colorado
PPO Only
Calendar Year Deductible (Individual / Family)
No Deductible
Annual Benefit Maximum2
$500 per person
Orthodontia Benefit Maximum
Includes Both Children and Adults
N/A
Right Start 4 Kids Program
N/A
Coinsurance (The Portion You Pay)
Diagnostic/Preventive Services
N/A
Basic Services
N/A
Major Services
N/A
Orthodontia
N/A
Base Plan
Delta Dental of Colorado
In–and Out-of-Network
Calendar Year Deductible (Individual / Family)1
$50 / $100
Annual Benefit Maximum3
$1,500 per person
Orthodontia Benefit Maximum
Includes Both Children and Adults
$1,000 lifetime maximum per person
Right Start 4 Kids Program4
Covers children up to their 13th birthday at 100% with no deductible
Coinsurance (The Portion You Pay)
Diagnostic/Preventive Services
0% (deductible waived)
Basic Services
20% after deductible
Major Services
50% after deductible
Orthodontia
50%
Buy-Up Plan
Delta Dental of Colorado
In–and Out-of-Network
Calendar Year Deductible (Individual / Family)
$50 / $100
Annual Benefit Maximum3
$2,000 per person
Orthodontia Benefit Maximum
Includes Both Children and Adults
$1,500 per person
Right Start 4 Kids Program4
Covers children up to their 13th birthday at 100% with no deductible
Coinsurance (The Portion You Pay)
Diagnostic/Preventive Services
0% (deductible waived)
Basic Services
20% after deductible
Major Services
50% after deductible
Orthodontia
50%
Notes:
- Waived for preventive/diagnostic & orthodontia services.
- Diagnostic/preventive services such as oral evaluation or exam (2 per year) and routine cleaning (2 per year).
- Diagnostic/Preventive services do not count toward your benefit maximum when you visit a Delta PPO dentist (see Prevention First below).
- For the same services outlined in the plan, up to the annual maximum, and subject to limitations and exclusions.
What is Covered?
Preventive Dental Services
- Cleaning and oral exam
- Fluoride treatment
- Sealants
- X-rays
Major Dental Services
- Inlays, onlays
- Crowns, bridges, dentures (repair & maintenance)
Basic Dental Services
- Filling
- Tooth removal
- Root canal
Orthodontia
- Appliances, including braces and retainers
Prevention First
Mercy Housing’s dental plans include the “Prevention First” program, which allows you to stretch your benefits. With Prevention First, diagnostic and preventive services do not count against your annual maximum. This feature can be useful if you need additional treatment during the year.
See your Summary Plan Description linked above or contact your Benefits Manager for a list of covered services, limitations and exclusions.
Know Your Cost Before Your Visit
When charges for dental treatment (other than emergency treatment) are expected to exceed $400, you should ask your dentist for a pretreatment estimate before treatment begins.
Finding a Dentist
To find a participating dentist or to see if your dentist is in the PPO network, visit Delta’s website at deltadentalco.com/dentist-search.
Delta Dental also provides a mobile app that gives you access to the dentist search tool, claims and coverage, ID cards, and more, right on your mobile device.
Your Benefit Deductions
Benefit deductions are calculated on 26 pay periods per year. Deductions will begin on the first paycheck following your benefits effective date. Your portion of premiums is automatically deducted from your paycheck pretax, unless required to be post-tax. This reduces your taxable income, which lowers your tax liability.
Employee Only
Preventive PPO Plan: $0.00
Base Plan: $4.61
Buy-up Plan: $9.69
Employee + Spouse
Preventive PPO Plan: N/A
Base Plan: $25.38
Buy-up Plan: $36.46
Employee + Child(ren)
Preventive PPO Plan: N/A
Base Plan: $22.15
Buy-up Plan: $32.76
Employee + Family
Preventive PPO Plan: N/A
Base Plan: $42.92
Buy-up Plan: $59.07
Contact the provider of these benefits:
Delta Dental of Colorado - (800) 610-0201, www.deltadentalco.com
NOTE: Your plan name is Delta Dental of Colorado, regardless of state where you reside.
ABOUT THIS GUIDE: Actual plan provisions for Mercy Housing (“the Company”) benefits are contained in the appropriate plan documents, including the Summary Plan Description (SPD) and incorporated benefit/carrier booklets. The Digital Benefits Hub is a summary only and does not describe each benefit option. This Digital Benefits Hub provides updates to your existing SPD as of the first day of plan year, which describes your health and welfare benefits in greater detail. Until the Company provides you with an updated SPD, this guide is intended to be a Summary of Material Modification (SMM) and should be retained with your records along with your SPD. As always, the official plan documents determine what benefits are available to you. If any discrepancy exists between this guide and the official documents, the official documents will prevail. The Company reserves the right to amend or terminate any of its plans or policies, make changes to the benefits, costs, and other provisions relative to benefits at any time with or without notice, subject to applicable law.