Cost of wisdom teeth removal with delta dental insurance

Coverage Options:  

Option 1     

Option  2           

Annual Benefit Maximum

$1,000

$1,000

Coverage Options:  

Option 1

Option 2

Examples of Covered Services and Co-Insurance Levels:

Co-Insurance Type 1
Preventive (No Waiting Period)

Diagnostic Services

Preventive

 100%

100%

Co-Insurance Type 2

Basic Restorative (A 6-month waiting period may apply)

80%

50%

Restorative

Endodontics

Oral Surgery*

Periodontics*

Co-Insurance Type 3
Major Restorative (A 12-month waiting period may apply)

50%

40%

Prosthodontics*

Major Restorative

* No benefits are available for the replacement of teeth missing prior to the member’s effective date of coverage.

Monthly Premium for Subscribers that are age 50 and older:

Option 1   

Option  2     

Single:

$61.75

$49.60

Single +1:

$124.62

$100.13

Family:

$192.00

$154.26

Monthly Premium for subscribers that are under the age of 50

Option 1    

Option  2     

Single:

$58.38

$46.90

Single +1:

$110.03

$88.41

Family:

$187.50

$150.63

Above rates are valid for applications postmarked after March 10, 2018. Applications postmarked by the 10th of the
month will become effective the 1st of the following month. Examples: Applications postmarked June 10 will have an Effective Date of July 1. Applications postmarked June 11 will have an Effective Date of August 1.

Note: No benefits are available for the replacement of teeth missing prior to the member’s effective date of coverage.

Deductible: 

There is a $50 deductible per person up to $150 per family, on Basic and Major Restorative Services.
 

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