Dental Benefits

Graduate student employees and fellows who are enrolled in the Graduate Student Employee Health Plan will have the following dental benefits provided through Delta Dental. Services must be received from a participating dentist. No card is needed. Claim forms can be picked up at your graduate student health insurance office or the dentist may have some.

Your group number is 1996.

Dental Treatment Costs

Dental ServicesDeductiblePaid by PlanPaid by Patient
Diagnostic visits,
exams, x-rays,
diagnosis
None75%25%
Preventive cleaning,
fluoride,
space maintainer,
child sealants
None75%25%
Basic Restorative,
amalgam and
composite fillings
$10093%7%

Subject to a contract year deductible of $100 per person for Basic Restorative Services.

Diagnostic and Preventive services are exempt from the deductible.

Diagnostic
Procedure to assist dentist to evaluate existing conditions and dental care required to include visits, exams, diagnosis and x-rays (exams and bitewing x-rays twice in any 12 months period, full mouth x-rays are a benefit once in any three-year period).
Preventive
Prophylaxis (cleaning twice in any 12 month period), fluoride treatments (limited to age 19), space maintainers limited to age 14).
Basic Restorative
Amalgam ("silver") and composite ("white" non-molar) fillings.

Note: Orthodontic (straightening of teeth), Prosthodontic (replacement of missing teeth), Major Restorative (crowns, inlays, onlays), Oral Surgery (extractions), Periodontic (treatment of gums) and Endodontic (root canal therapy) services are not included above and are not covered under this contract. Maximum benefit $500 per person based on a contract year. The contract year ends August 14.

There are no benefits for services other than those listed above.

Delta Dental of New York
One Delta Drive
Mechanicsburg, PA 17055
Tel: (800) 932-0783 or (717) 766-8500

Participating dentists can be located through the Delta Dental website as follows:

  1. Visit www.deltadental.com.
  2. Searching for a dentist? Start here.
  3. Your Dental Plan: Delta Preferred.
  4. Provide requested information.
  5. Participating dentists in your area will be listed.

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