Retiree Dental Plan

http://www.deltadentalins.com
(800) 932-0783

FCPS offers two dental plans administered by Delta Dental. Effective January 1, 2020, one is a standard plan with an annual limit of $1500 per person per plan year and one is a buy-up option plan with an annual limit of $2500 per person per plan year. Your plan will run on a calendar year basis from January 1^st through December 31^st.

Delta Dental Plan Highlights - Effective January 1, 2022

Dental Services	Standard Plan PPO – in-network	Standard Plan Out-of-Network	Buy-Up Plan PPO – in-network	Buy-Up Plan Out-of-Network
Deductibles	$0	$50 ind/$150 fmly	$0	$50 ind/$150 fmly
Diagnostic & Preventive	100%	100%	100%	100%
Basic Services	80%	80%	80%	80%
Major Services	50%	50%	50%	50%
Orthodontics Maximums	Unlimited Maximum  $0 per person lifetime	deductible $2,000 per person $50 per person lifetime deductible	Unlimited Maximum  $0 per person lifetime	deductible $2,000 per person $50 per person lifetime deductible
Maximum per person per Plan Year	$1,500 per person	$1,500 per person	$2,500 Per person	$2,500 per person

The above is intended for highlight information only.  Please refer to the detailed plan summary for the Standard Dental Plan or the Buy-up Dental Plan for exclusions and specific plan details. 

You can make changes to your Dental from standard plan to the buy-up plan during your open enrollment in October for January 1st by completing the Retiree Dental Buy Up Enrollment Form.

Links

Evidence of Coverage - Standard Plan
Evidence of Coverage - Buy-Up Plan