Notice
From Friday May 23rd through Friday, August 29, 2025: Customer Service hours will be 8:00 AM – 6:30 PM EST Monday through Thursday and 8:00 AM - 1:00 PM EST on Friday.
To view benefit information and claim status at any time, you can sign into your account or use our Interactive Voice Response System 24/7 at 800-452-9310.
Premium plan benefit summary
Delta Dental Unlimited Program for UPFFA CT Locals (endorsed and administrated by the IAFF Health & Wellness Trust)
Plan Highlights
- Unlimited calendar year maximum for all networks
- 100% coverage for most services if seeing a PPO Dentist
- Implant and Orthodontic coverage
| Service | In-Network If a Delta Dental PPO™ Dentist is Used |
In-Network If a Delta Dental Premier® Dentist is Used |
Out-of-Network If a Non-Participating Dentist is Used |
|---|---|---|---|
| Calendar year maximum (per person) | Unlimited | Unlimited | Unlimited |
| Annual deductible (waived on Preventive & Diagnostic) | |||
| Per person | None | $200 | $200 |
| Family maximum | None | $600 | $600 |
| Preventive | |||
| Exams | 100% | 80% | 80% |
| Bitewing X-rays | 100% | 80% | 80% |
| Full mouth X-rays (a series of individual X-rays or a panoramic X-ray) | 100% | 80% | 80% |
| Diagnostic | |||
| Cleanings | 100% | 70% | 70% |
| Fluoride (to age 19) | 100% | 70% | 70% |
| Sealants | 100% | 50% | 50% |
| Space maintainers | 100% | 50% | 50% |
| Basic | |||
| Fillings (composite fillings on all teeth) | 100% | 50% | 50% |
| Simple extractions | 100% | 50% | 50% |
| Cone Beam Radiographs | 100% | 50% | 50% |
| Repair of Dentures | 100% | 50% | 50% |
| Oral Surgery | 100% | 50% | 50% |
| Anesthesia/IV Sedation | 100% | 50% | 50% |
| Major Services | |||
| Endodontics – The care of teeth with damaged nerves, such as root canal treatment | 100% | 50% | 50% |
| Crowns – Repair of teeth with crowns when they cannot be restored with other filling materials | 90% | 50% | 50% |
| Periodontics – The treatment of disease of the gums and supporting bone, such as scaling and root planing | 90% | 50% | 50% |
| General services (Consultation) | 60% | 50% | 50% |
| Oral surgery – Surgical extractions and other dental surgery | 50% | 50% | 50% |
| Bridgework; bridges | 50% | 50% | 50% |
| Implants | |||
| Treatment | 50% | 50% | 50% |
| Annual TMJ maximum (per person) | $2,000 | $2,000 | $2,000 |
| TMJ | |||
| Treatment | 50% | 50% | 50% |
| Annual TMJ maximum (per person) | $1,000 | $1,000 | $1,000 |
| Lifetime TMJ maximum (per person) | $5,000 | $5,000 | $5,000 |
| Orthodontics | |||
| Treatment (Adult & Child) | 50% | 50% | 50% |
| Lifetime Orthodontics maximum (per person) | $1,000 | $1,000 | $1,000 |
