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Group benefit summaries Alaska


Quickly and easily download everything you and your employees need for enrolling in a Delta Dental plan, filing claims and administering benefits.

View benefit summaries below:



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.

2021 Alaska Small Group dental plans (1-50)

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

2021 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®, 1500, 80*/80/50,50 $50 $1,500 20%
Delta Dental Premier®, 2000, 80*/80/50,50 $50 $2,000 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® 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®, +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, 80*/80/50,50 $50 $1,000 20%
Delta Dental Premier®, Voluntary, 1000, 100*/80/50,50 $50 $1,000 0%
Delta Dental Premier®, Voluntary, 1500, 80*/80/50,50 $50 $1,500 20%
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 $2,000 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%
1Includes coverage for nitrous with a 12-month exclusion period, and Preventive First (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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