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Group plan documents Alaska

Quickly and easily download everything you and your employees need for enrolling in a Delta Dental plan, filing claims and administering benefits. Employers should log into their Employers Dashboard to access their plan documents or contact their agent or sales for help.

View benefit summaries below:

2023 Alaska Small Group dental plans (1-50)

Amounts are what members pay (in-network per person for ages 19+) 2023 ALASKA
Plan Deductible Annual Max Exams and cleanings
Premier Plans
Delta Dental Premier® 1000 100/80/50 50 $50 $1,000 0%
Delta Dental Premier® 1500 100/80/50 50 $50 $1,500 0%
Delta Dental Premier® 2000 100/80/50 50 $50 $2,000 0%
Delta Dental Premier® Radiant Smiles Plan $50 N/A 0%
Delta Dental Premier® Preventive Mandated Plan $25 N/A 0% after deductible
Premier Preventive First Plans
Delta Dental Premier® +1000 100/80/50 50 PF $50 $1,000 0%
Delta Dental Premier® +1500 100/80/50 50 PF $50 $1,500 0%
Delta Dental Premier® +2000 100/80/50 50 PF $50 $2,000 0%
Delta Dental Premier® +2500 100/80/50 50 PF $50 $2,500 0%
Delta Dental Premier® +3000 100/80/50 50 PF $50 $3,000 0%
PPO Plans
PPO Plus 1 $25 $1,100 0%*
PPO Plus 2 $25 $1,600 0%*
PPO Plus 3 $25 $2,100 0%*
PPO Plus 4 $25 $2,600 0%*
PPO Plus 5 $25 $3,100 0%*
PPO Preventive First Plans
Delta Dental PPOSM PF 1000 100/90/50 50 $50 $1,000 0%
Delta Dental PPOSM PF 1500 100/90/50 50 $50 $1,500 0%
Delta Dental PPOSM PF 2000 100/90/50 50 $50 $2,000 0%
Delta Dental PPOSM +2500 100/90/50 50 $50 $2,500 0%
Delta Dental PPOSM +3000 100/90/50 50 $50 $3,000 0%
PPO Preventive First Voluntary Plans
Delta Dental PPOSM PF Voluntary 1000 100/90/50 50 $50 $1,000 0%
Delta Dental PPOSM PF Voluntary 1500,100/90/50 50 $50 $1,500 0%
Delta Dental PPOSM PF Voluntary 2000 100/90/50 50 $50 $2,000 0%

2022 Alaska Small Group dental plans (1-50)

Amounts are what members pay (in-network per person for ages 19+)



2022 ALASKA
Plan Deductible Annual Max Exams and cleanings
Premier Plans
Delta Dental Premier®, 1000, 80*/80/50,50 $50 $1,000 20%
Delta Dental Premier®, 1000, 100*/80/50,50 $50 $1,000 0%
Delta Dental Premier®, 1500, 100*/80/50,50 $50 $1,500 0%
Delta Dental Premier®, 2000, 100*/80/50,50 $50 $2,000 0%
Delta Dental Premier®, 2500, 100*/80/50,50 $50 $2,000 0%
Delta Dental Premier®, 3000, 100*/80/50,50 $50 $2,000 0%
Delta Dental Premier® Preventive Mandated Plan $25 $500 0% after deductible
Delta Dental Premier® Radiant Smiles Plan $50 Not covered Not covered
Premier Preventive First Plans
Delta Dental Premier®, +1000, 100*/80/50,50,PF1 $50 $2,000 0%
Delta Dental Premier®, +1500, 100*/80/50,50,PF1 $50 $2,000 0%
Delta Dental Premier®, +2000, 100*/80/50,50,PF1 $50 $2,000 0%
Delta Dental Premier®, +2500, 100*/80/50,50,PF1 $50 $2,500 0%
Delta Dental Premier®, +3000, 100*/80/50,50,PF1 $50 $3,000 0%
Premier Voluntary Plans
Delta Dental Premier®, Voluntary, 1000, 100*/80/50,50 $50 $1,000 0%
Delta Dental Premier®, Voluntary, 1500, 100*/80/50,50 $50 $1,500 0%
PPO Plans
Delta Dental PPOSM, 1000, 100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, 1500, 100*/90/50, 50 $50 $1,500 0%
Delta Dental PPOSM, 2000, 100*/90/50, 50 $50 $2,500 0%
PPO Preventive First Plans1
Delta Dental PPOSM, 2500, 100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, 3000, 100*/90/50, 50 $50 $1,500 0%
PPO Voluntary Plans
Delta Dental PPOSM, Voluntary, 1000,100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, Voluntary, 1500,100*/90/50, 50 $50 $1,500 0%
PPO Preventive First Voluntary Plans1
Delta Dental PPOSM, PF Voluntary, 2000,100/80/50, 50 $50 $2,000 0%
Delta Dental PPOSM, PF Voluntary, 2500,100/80/50, 50 $50 $2,500 0%
Delta Dental PPOSM, PF Voluntary, 3000,100/80/50, 50 $50 $3,000 0%
Delta Dental PPOSM, PF Voluntary, 2000,100*/80/50, 50 $50 $2,000 0%
Delta Dental PPOSM, PF Voluntary, 2500,100*/80/50, 50 $50 $2,500 0%
Delta Dental PPOSM, PF Voluntary, 3000,100*/80/50, 50 $50 $3,000 0%
*Deductible waived for diagnostic and preventive services.
1(Only Class 2 and Class 3 services apply to the annual maximum).
 
Plan Lifetime max Eligible employees Dependent children
Orthodontia riders
Adult & Child Ortho 1000 $1000 50% 50%
Adult & Child Ortho 1500 $1500 50% 50%
Adult Ortho 1000 $1000 50% Not covered
Adult Ortho 1500 $1500 50% Not covered
Child Ortho 1000 $1000 Not covered 50%1
Child Ortho 1500 $1500 Not covered 50%1
1Treatment must be started prior to the child's 17th birthday.

2022 Alaska large group plan material

Amounts are what members pay (in-network per person for ages 19+)

Alaska 2022 large group plan material
Plan Deductible Annual Max Exams and cleanings
Premier Plans
AKMandDent $25 $500 0%
W3X501 $50 $1,000 20%
B3X501 $50 $1,000 0%
W3X50 $50 $1,500 20%
B3X50 $50 $1,500 0%
W3X502 $50 $2,000 20%
B3X502 $50 $2,000 0%
L3X503 $50 $3,000 0%
Premier Preventive First Plans
B3X501_PF $50 $1,000 0%
B3X50_PF $50 $1,500 0%
W3X502_PF $50 $2,000 20%
B3X502_PF $50 $2,000 0%
L3X502_PF $50 $2,000 0%
L3X5025_PF $50 $2,500 0%
L3X503_PF $50 $3,000 0%
Premier Voluntary Plans
VB3X501 $50 $1,000 0%
VB3X50 $50 $1,500 0%
PPO Plans
BPA3X501 $50 $1,000 0%
BPA3X50 $50 $1,500 0%
BPA3X502 $50 $2,000 0%
BPA3X5025 $50 $2,500 0%
BPA3X503 $50 $3,000 0%
PPO Preventive First Plans
BPA3X501_PF $50 $1,000 0%
BPA3X50_PF $50 $1,500 0%
BPA3X502_PF $50 $2,000 0%
BPA3X5025_PF $50 $2,500 0%
BPA3X503_PF $50 $3,000 0%
PPO Voluntary Plans
VBPA3X501 $50 $1,000 0%
VBPA3X50 $50 $1,500 0%
     
Plan Lifetime max Eligible employees Dependent children
Orthodontia riders
Adult Ortho 1000 $1,000 50% Not covered
Adult Ortho 1500 $1,500 50% Not covered
Adult Ortho 2000 $2,000 50% Not covered
Adult & Child Ortho 1000 $1,000 50% 50%
Adult & Child Ortho 1500 $1,500 50% 50%
Adult & Child Ortho 2000 $2,000 50% 50%
Child Ortho 1000 $1,000 Not covered 50%1
Child Ortho 1500 $1,500 Not covered 50%1
Child Ortho 2000 $2,000 Not covered 50%1
1Covered only for children. Treatment must be started prior to child's 17th birthday.


 

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