If you enroll in State Group Health (SGH) Insurance, you may elect the Uniform Dental Benefit (UDB) for routine preventive and basic dental services. An additional cost will be added to your monthly health insurance premium. If you are not enrolled in SGH, you may elect the Preventive Dental plan to cover basic and preventive dental services.
| Uniform Dental | |
|---|---|
| Monthly Premium Added to your health insurance premium Employees working less than 50% should review premium costs |
$3Â (Individual), $10 (Family) |
| In-Network Providers No out-of-network coverage |
Delta Dental PPO or Premier providers |
| Annual Deductible | None |
| Annual Benefit Max | $1,000 per person |
| Waiting Period | None |
| Diagnostic and Preventive Services | |
| Routine evaluations, dental cleanings, sealants, bitewing and panoramic X-rays, fluoride treatments | 100% |
| Basic Services | |
| Fillings | 100% |
| Anesthesia (general and IV sedation) | 80% |
| Emergency pain relief | 80% |
| Periodontal Maintenance | 80% |
| Major/Restorative Services | |
| Crowns, bridges, dentures, implants | No coverage |
| Surgical extraction, root canal (endodontics), periodontics (except maintenance), oral surgery | No coverage |
| Non-surgical extractions | 90% |
| Orthodontics | |
| Coverage | 50% (Under age 19) |
| Lifetime Maximum | $1,500 |
If you need additional coverage for major/restorative dental services or adult orthodontia, see the supplemental dental options.
Contact Delta Dental
Delta Dental Customer Care:Â Â 844-337-8383
Group # 50316-001
Publications
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UDB Highlights
Search for a network dentist and review coverage details.
- Dental Brochure
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UDB Certificate of Coverage
Details of services that will and will not be covered.
- Summary Plan Description
- Dental Plan Comparison Chart
- Dental enrollment form, only used for Preventive and Supplemental Dental (not UDB)