Dental Plan Coverage Comparison Charts

Compare coverage for the following employee health care plans: Aetna DMO, Aetna Premium DMO, Delta Dental Base, and Delta Dental Premium. This comparison is for benefits-eligible faculty and academic staff (FAS) and support staff (SS). Plan eligibility is determined by employee type and union affiliation (if any):

  • Aetna DMO: Support staff in the 274, AP, and POAM unions are eligible.
  • Aetna Premiums DMO: Faculty, academic staff, and support staff in the following unions are eligible: APSA, CTU, 324, 1585, SSTU, Nurses, Resident Advisors, and MSU Extension.
  • Delta Dental Base and Delta Dental Premium: All employees are eligible.

Disclaimer: this comparison reviews the plan features in general terms, but is not a full description of coverage. This page may be updated periodically to ensure we provide the clearest and most accurate information. We encourage you to review your plan provider's benefit and coverage summary for more detail.

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Dental Plan Maximums

Review these important definitions:

  • Annual Maximum: The maximum amount the dental plan will cover in a benefit year. Once you reach this amount, you are responsible for 100% of the cost.
  • Lifetime Maximum: The maximum amount your plan will ever pay for a specific dental service. Once you reach this amount, you are responsible for 100% of the cost.
Benefit Aetna DMO (Plan 41) Aetna Premium DMO (Plan 67) Delta Dental Base Plan Delta Dental Premium Plan
Annual Maximum No maximum No maximum $600 maximum2 $2,000 maximum3
Lifetime Orthodontics No maximum No maximum $600 maximum $2,000 maximum

Diagnostic and Preventative Services

Benefit Aetna DMO (Plan 41) - Support Staff Only Aetna Premium DMO (Plan 67) Delta Dental Base Plan Delta Dental Premium Plan
Exams $20 copay No copay 50% patient pay 0% patient pay
Cleanings No copay No copay 50% patient pay 0% patient pay
X-rays No copay No copay 50% patient pay 0% patient pay
Fluoride No copay No copay
1 per year, age 15 and under 		50% patient pay
less than age 19 		0% patient pay
less than age 19
Sealants
 to prevent decay of permanent molars for dependents 		$10 copay
per tooth4 		$10 copay
per tooth4 		Not covered 0% patient pay
see age limitations
Space Maintainers $100 copay $80 copay
fixed and removable 		50% patient pay
less than age 19 		0% patient pay
less than age 19

Minor Restorative

Benefit Aetna DMO (Plan 41) - Support Staff Only Aetna Premium DMO (Plan 67) Delta Dental Base Plan Delta Dental Premium Plan
Amalgam Silver Fillings $22 copay
per filling 		No copay 50% patient pay 30% patient pay
Composite Resin Fillings
 anterior teeth only 		$40 copay
per filling 		No copay 50% patient pay 30% patient pay

Prosthetics

Benefit Aetna DMO (Plan 41) - Support Staff Only Aetna Premium DMO (Plan 67) Delta Dental Base Plan Delta Dental Premium Plan
Crowns
 semi-precious 		$488 copay $315 copay 50% patient pay 50% patient pay
Bridges
 per unit 		$488 copay $315 copay 50% patient pay 50% patient pay
Denture
 for each 		$500 copay $320 copay 50% patient pay 50% patient pay
Partial
 for each 		$513-$719 copay $320-$460 copay 50% patient pay 50% patient pay

Oral Surgery

Benefit Aetna DMO (Plan 41) - Support Staff Only Aetna Premium DMO (Plan 67) Delta Dental Base Plan Delta Dental Premium Plan
Simple Extraction $12 copay No copay 50% patient pay 30% patient pay
Extraction - Erupted Tooth $30 copay No copay 50% patient pay 30% patient pay
Extraction - Soft TIssue Impaction $80 copay $60 copay 50% patient pay 30% patient pay
Extraction - Partial Bony Impaction $175 copay $80 copay 50% patient pay 30% patient pay
Extraction - Complete Bony Impaction $225 copay $120 copay 50% patient pay 30% patient pay

Endodontics

Benefit Aetna DMO (Plan 41) - Support Staff Only Aetna Premium DMO (Plan 67) Delta Dental Base Plan Delta Dental Premium Plan
Anterior Root Canal $150 copay $120 copay 50% patient pay 30% patient pay
Bicuspid Root Canal $195 copay $180 copay 50% patient pay 30% patient pay
Molar Root Canal $435 copay $300 copay 50% patient pay 30% patient pay
Apicoectomy $130-$190 copay $170 copay 50% patient pay 30% patient pay

Periodontics

Benefit Aetna DMO (Plan 41) - Support Staff Only Aetna Premium DMO (Plan 67) Delta Dental Base Plan Delta Dental Premium Plan
Gingivectomy
 per quadrant 		$160 copay
see Summary Plan Description for details 		$125 copay
see Summary Plan Description for details 		50% patient pay 30% patient pay
Osseous Surgery
 per quadrant 		$445 copay $375 copay 50% patient pay 30% patient pay
Root Scaling
 per quadrant 		$65 copay $60 copay 50% patient pay 30% patient pay

Orthodontics

Benefit Aetna DMO (Plan 41) - Support Staff Only Aetna Premium DMO (Plan 67) Delta Dental Base Plan Delta Dental Premium Plan
Child
 under age 19 		$3,000 copay1 $1,500 copay1 50% patient pay 50% patient pay
Adult
 age 19 or older 		$3,000 copay1 $1,500 copay1 Not covered 50% patient pay

Footnotes

Please Note: This summary reviews the plan features in general terms, but is not a full description of coverage.

Footnotes:

  1. Includes screening exam, diagnostic records, orthodontic treatment, and orthodontic retention. Phase 1 orthodontic services are not covered, which includes treatment to prepare the mouth to be fully banded or possibly avoic a comprehensive treatment plan.
  2. Diagnostic and preventative services apply to the annual maximum.
  3. Diagnostic and preventative services do not apply to the annual maximum.
  4. Once per tooth every three rolling years on permanent molars only for children under age 16.