Dental II Plan Details

How an Individual Uses Dental Services

Dental care under the Dental II plan may be obtained from any provider you wish. However, how much you pay for care will depend on the tier level of the provider you choose.

Dental II is a 3 tier provider network within Delta Dental.

Tier Level Providers per Tier
Tier 1 PPO network
Tier 2 Regular Delta Dental network
Tier 3 Dentists who do not participate with Delta Dental

What is a PPO network?
PPO stands for Preferred Provider Organization. This means that any Delta Dental providers participating in the PPO or Regular Delta Dental network (Tier 1 and 2) will accept payment arrangements and file claims for you with Delta Dental of Iowa. Payment is made directly to these providers. A person using a PPO Delta Dental provider will see a reduced cost for care. Check the Delta Dental of Iowa website for a list of providers in the PPO and Regular network.

All of the other providers (Tier 3) are Non-participating providers and do not have contracts with Delta Dental of Iowa. They do not agree to accept payment arrangements and are not responsible for filing claims for you. Non-participating providers may charge more for dental care than participating providers. Payment is made to you and you are responsible for paying the provider.

The benefit period is the same as the calendar year.

How Much an Individual Pays for Dental Care Services

Diagnostic and Preventive Maintenance Care

Benefit Period Calendar Year
Annual Deductible (per member) None
Co-insurance: Plan/Member 100% / 0%
Maximum Annual Benefit (per member) Two per year

Diagnostic and Preventive Maintenance Care Benefits include:

  • Routine examination
  • Teeth cleaning
  • Diagnostic services
  • Special preventive care for children
  • X-rays

Routine and Restorative Care

Provider Tier PPO Premier Non-participating
Annual Deductible (Per Member) None None None
Co-insurance: Plan/Member 100% / 0% 80% / 20% 80% / 20%
Maximum Annual Benefit (Per Member)* $2000, up to $4000 with annual carryover

Routine and Restorative Care includes:

  • Regular cavity fillings
  • Emergency treatment for relief of pain
  • Routine oral surgery
  • Anesthesia
  • Extractions

Dental Prosthetics, Endodontic, Periodontal, and High Cost Restorations

Provider Tier PPO Premier Non-participating
Annual Deductible (Per Member) None None None
Co-insurance: Plan/Member 90% /10% 80% / 20% 80% / 20%
Maximum Annual Benefit (Per Member)* $2000, up to $4000 with annual carryover

Dental Prosthetics, Endodontic Services, Periodontal Services and High Cost Restorations include:

  • Bridges, partial and complete dentures
  • Crowns
  • Root Canals
  • Implants

Straighter Teeth (Orthodontic Care)

Benefit Period Calendar Year
Annual Deductible (per Member) $0
Coinsurance: Plan/Member 50% / 50%
Maximum Annual Benefit (per Member)* $2000, up to $4000 with annual carryover

Straighter Teeth Care Include:

  • Treatment necessary for the proper alignment of teeth
  • Orthodontic benefits are paid quarterly

*Maximum Annual Benefit (per member):

$2,000 includes all covered services per member. The annual benefit maximum for Dental II includes a carryover feature from one calendar year to the next.  If you do not use all of your $2,000 maximum, have been covered the full year, and submitted at least one claim, what remains will carryover and be added to your annual maximum in the following year up to $4,000.

To check what tier your dentist falls in, you can visit the Delta Dental of Iowa website to search for your provider. 

ABOUT OUR SITE: The information presented on our website describes only the highlights of the plans and does not constitute official plan documents. Additional terms and conditions apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern.

Contact Information

University Benefits

Fax
319-335-2776
Campus Address
120 USB
Mailing Address

120 University Services Building
Iowa City, IA 52242-1911
United States

Hours
Monday-Friday, 8 a.m.-5 p.m.