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We will be closed on Thursday, June 19, in observance of Juneteenth. This federal holiday marks June 19, 1865, when slavery officially ended in the United States. To learn more about this important historical day, please visit this resources page.


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Webster Bank Delta Dental PPO plus Premier™ - Plan Comparison

Group #04759

Residents of AK, LA, MS, MT, & TX



  Basic Plan Enhanced Plan 
Service If a Delta Dental PPO Network Dentist is used  If a Delta Dental Premier or Non-Network Dentist is used  If a Delta Dental PPO Network Dentist is used  If a Delta Dental Premier or Non-Network Dentist is used 
Calendar year maximum (per person) $1,500 $1,500  $3,000  $3,000
Calendar year deductible (waived on Preventive & Diagnostic)      
    Per person $100 $100 $50 $50
    Family aggregate $300 $300 $150 $150
         
Preventive & Diagnostic 
Plan Pays:
Plan Pays:
Plan Pays:
Plan Pays:
    Exams, Cleanings (2 per calendar year) 100% 80% 100% 100%
    Bitewing X-rays (2 per calendar year to age 18; 2 per calendar year for 19+)              100% 80% 100% 100%
    Fluoride Treatment (2 per calendar year to age 18) 100% 80% 100% 100%
    Full mouth X-rays (1 per 5 years) 100% 80% 100% 100%
Basic Services (after deductible)        
    Fillings (composite on all teeth)           80% 80% 100% 100%
    Simple extractions 80% 80% 100% 100%
    Root canals (Endodontics) 50% 50% 100% 100%
    Periodontics, Periodontal maintenance (4 per calendar year; interchangable with cleanings) 80% 80% 100% 100%
    Cone Beam X-Rays 80% 80% 100% 100%
    Sealants 80% 80% 100% 100%
    Repair of dentures            50% 50% 100% 100%
    Oral surgery 80% 80% 100% 100%
    Athletic mouth guards 80% 80% 100% 100%
Major Services        
    Crowns, Inlays, & Gold Restorations 50% 50% 60% 60%
    Bridgework, Full & Partial Dentures 50% 60% 60% 60%
    Implants 50% 60% 60% 60%
Orthodontics (Adult and Child)        
    Co-insurance              Not a benefit Not a benefit 60% 60%
    Lifetime maximum  N/A N/A $2,500 $2,500

Your dentist's network will impact how much you pay. Dentists that help participate in the Delta Dental PPO will have the lowest costs and will save you the most out of pocket expense. Dentists that participate in Delta Dental Premier, are participating Delta Dental dentists, but you will pay a greater portion of the cost if utilized. If you receive services from a non-participating, out of network dentists, you will pay the most out of pocket and are responsible for your coinsurance amount plus the difference between Delta Dental's approved fee and the dentist submitted fee for the claim.