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.
Monthly Premiums
| 2026 Monthly Employee Premiums | Individual | Family |
|---|---|---|
| Monthly Premium Added to your health insurance premium |
$4 | $10 |
Schedule of Benefits
| Schedule of Benefits | Uniform Dental |
|---|---|
| Provider Network | Delta Dental PPO and Delta Dental Premier |
| Deductible | None |
| Annual Benefit Maximum | $1,000 per person |
| Diagnostic and Preventive Services Routine evaluations, dental cleanings, sealants*, bitewing and panoramic X-rays, fluoride treatments*, pulp vitality tests, fillings and periodontal maintenance *for children to age 19 |
100% |
| Non-Surgical Extractions (above gumline) | 90% |
| Major/Restorative Services Crowns, bridges, dentures, root canal therapy (endodontics) |
Not covered |
| Orthodontics (Under Age 19) | Coverage: 50% Lifetime Maximum: $1,500 Waiting Period: None |
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
-
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)