Menu

DENTAL

DENTAL

Resources
Delta Dental High Plan Benefit Summary
Delta Dental Low Plan Benefit Summary
Choosing a Dental Network
How We Pay Ortho
Member Portal
Pre-Treatment Estimate
Reference Card
Welcome Letter
Videos
Dental Insurance

Delta Dental– Group #1170

Hudson City Schools District offers two types of dental plans – the Dental Plan High or the Dental Plan Low.

Please see the below breakdown of each plan.

Dental High Plan 
  • Basic dental services (fillings, root canals, etc): 80%/20% co-insurance
  • Major dental services (crowns, dentures, etc): 60%/40% co-insurance
  • Orthodontic services: 60%/40% coinsurance, $2,500 lifetime maximum
  • $2,500 yearly maximum (excluding orthodontic services)

High Plan

  Delta Dental PPO
Dentist Plan Pays		 Delta Dental Premier Dentist Plan Pays Nonparticipating Dentist Play Pays
Diagnostic & Preventive
Diagnostic and Preventive Services – exams, cleanings, fluoride, and space maintainers
100%
100%
 
100%
 
Emergency Palliative Treatment – to temporarily relieve pain 100%
100%
 100%
Basic Services
Minor Restorative Services – fillings and crown repair 80% 80% 80%
Endodontic Services – root canals 80% 80% 80%
Other Basic Services 80% 80% 80%
Major Services
Major Restorative Services – crowns 60% 60% 60%
Prosthodontic Services – bridges, implants, dentures and crowns over implants 60% 60% 60%
Orthodontic Services
Orthodontic Services – braces
No Age Limit		 60% 60% 60%

This is just a “benefits at a glance” please refer to the full Summary of Benefits for more.

Dental Low Plan 
  • Basic Dental Services 50%
  • Major Restorative Services 25%
  • $1,000 orthodontic lifetime maximum
  • $1,500 yearly maximum (excluding orthodontic services)

Low Plan

  Delta Dental PPO
Dentist Plan Pays		 Delta Dental Premier Dentist Plan Pays Nonparticipating Dentist Play Pays
Diagnostic & Preventive
Diagnostic and Preventive Services – exams, cleanings, fluoride, and space maintainers
100%
100%
 
100%
 
Emergency Palliative Treatment – to temporarily relieve pain 100%
100%
 100%
Basic Services
Minor Restorative Services – fillings and crown repair 50% 50% 50%
Endodontic Services – root canals 50% 50% 50%
Other Basic Services 50% 50% 50%
Major Services
Major Restorative Services – crowns 25% 25% 25%
Prosthodontic Services – bridges, implants, dentures and crowns over implants 25% 25% 25%
Orthodontic Services
Orthodontic Services – braces
No Age Limit		 50% 50% 50%

This is just a “benefits at a glance” please refer to the full Summary of Benefits for more.