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How the Dental Plans Work
Salem Health gives you the choice of dental plans through Delta Dental: Dental Basic plan or Dental + Orthodontia plan. All family members must be enrolled under the same plan. You cannot split coverage plans between family members.
With both plans, you have the freedom to choose any dentist or dental care provider. When using a Delta Dental PPO dentist or a Delta Dental Premier dentist, the dentist may not charge you the difference between the plan allowance and the billed amount for covered services. You will pay the least out of your pocket when you visit a Delta Dental PPO dentist.
Both plans fully cover preventive services, such as regular exams and cleanings. They also provide coverage for basic and major services, but only the Dental + Orthodontia plan offers orthodontia benefits.
Delta Dental Premier provider: $$
Out-of-network provider: $$$
| Delta Dental Passive PPO Network |
Dental Plan | Dental + Orthodontia Plan |
|---|---|---|
| Annual deductible | $25 individual/$75 family | $25 individual/$75 family |
|
Annual maximum (preventive services are not applied to annual) |
$1,500 per person | $1,500 per person |
|
Preventive services (e.g., oral exams, cleanings, bitewing, x-rays) |
0%; deductible does not apply | 0%; deductible does not apply |
|
Basic services (e.g., fillings, roots canals, oral surgery) |
20% after deductible | 20% after deductible |
|
Major services (e.g., crowns, bridges, implants) |
50% after deductible | 50% after deductible |
|
Orthodontia (for both adults and children) |
Not covered | 50% to lifetime maximum benefit of $1,500 per person |
Delta Dental NonDiscrimination
2025 Dental+Ortho Summary
2025 Dental+Ortho Spanish Summary
2025 Dental Basic Summary
2025 Dental Basic Spanish Summary
