Sewanee Benefits

Dental

Dental coverage helps you maintain routine preventive care and manage larger needs over time. This page is here to help you understand what the plan includes, how the base and enhanced options differ, where to go for next steps, and what to do when you have questions about treatment, claims, or access to care.

Start here

Not sure where to begin? Start with the option that best matches what you need right now.

What’s included

Delta Dental PPO + Premier Access

Delta Dental of Tennessee gives members access to both the Delta Dental PPO and Delta Dental Premier networks. Participating dentists provide negotiated rates, and members using participating dentists are not balance billed. That means they cannot bill you for the difference between their full charge and the plan’s allowed amount. Nonparticipating dentists may cost more and may bill you for that difference.

Preventive, Basic, Major, and Orthodontic Services

Preventive services are covered at 100%. Basic services are covered at 80%, major services at 50%, and orthodontia for children up to age 19 is covered at 50%, subject to plan limits.

Base and Enhanced Options

Both options use the same $50 individual / $150 family calendar year deductible and both cover preventive care at 100%. The main difference is the annual maximum: the base option has a $1,000 annual maximum, while the enhanced option increases that amount to $2,000.

Online Tools and Member Access

Delta’s member tools allow employees to find participating dentists, check benefits, review claims, monitor deductibles and maximums, and print ID cards.

How it works

Deductible
The deductible is $50 per person, up to $150 per family, each calendar year. It does not apply to preventive services or certain other listed services.
Annual Maximum
The base plan pays up to $1,000 per person each calendar year. The enhanced plan increases that annual maximum to $2,000.
Preventive Care
Exams, cleanings, fluoride, X-rays, sealants, brush biopsy, and periodontal maintenance are covered at 100%.
Basic Services
Basic services such as fillings, simple extractions, some non-surgical gum treatment, certain oral surgery, and certain repairs are covered at 80%.
Major Services
Major services such as crowns, dentures, bridges, implants, root canals, surgical extractions, and certain surgical gum services are covered at 50%.
Orthodontia
Orthodontic services for children up to age 19 are covered at 50%, subject to the orthodontic lifetime maximum.
PPO vs. Premier vs. Nonparticipating
You can use PPO, Premier, or nonparticipating dentists. PPO and Premier dentists provide negotiated rates. Nonparticipating dentists may cost more and may balance bill you.
Calendar Year
Dental deductibles and annual maximums track on a calendar-year basis, so timing can matter if you expect larger treatment.

Compare the dental plans

Base Dental

The base plan is the current core option. It uses a $50 / $150 deductible, covers preventive services at 100%, and includes a $1,000 annual maximum.

Good fit if: you mainly want preventive care and a lower payroll cost.
Enhanced Dental

The enhanced plan keeps the same deductible and basic coverage structure, but increases the annual maximum to $2,000 and the orthodontic lifetime maximum to $2,000.

Good fit if: you expect more dental work and want more annual protection against larger claims.

Before you…

Before you schedule care
Confirm whether the dentist is PPO, Premier, or nonparticipating.
Ask the office for a treatment estimate if anything beyond preventive care is planned.
Think about whether you have already used some of your annual maximum this year.
Use your HSA or FSA if you plan to pay eligible out-of-pocket dental expenses.
Before you start major treatment
Ask the office to submit a pretreatment estimate when appropriate.
Check how much deductible and annual maximum remain.
Ask whether treatment can be phased across calendar years, if timing matters.
Confirm what you may owe before agreeing to treatment.
Before you pay a bill
Wait for the claim to process through Delta when possible.
Compare the office bill to your claim detail or EOB.
Call the dental office if something does not line up.
Contact Delta or the Benefits team if you need help sorting it out.

Common questions

Click a section below to view common questions and next steps.

Finding a dentist and using the network
How do I find an in-network dentist?
Use Delta Dental’s online provider search tool. Participating dentists can be found on Delta Dental of Tennessee’s website.
What is the difference between PPO and Premier?
Both are participating Delta Dental networks. The main practical point is that participating dentists give you negotiated rates and stronger protection from extra billing than nonparticipating dentists.
Can I see a dentist who is not in Delta Dental’s network?
Yes, but you may pay more. Nonparticipating dentists may balance bill you.
Where do I get my dental ID card?
Delta’s member tools let employees print ID cards and review benefits online. That is usually the easiest place to start.
What if I already have a dentist and want to know whether they participate?
Look the office up in Delta’s provider search and then confirm directly with the office before your appointment. It is worth checking both the dentist and the location.
Treatment planning and how services are covered
What kinds of services are preventive?
Preventive services include exams, cleanings, fluoride, X-rays, sealants, brush biopsy, and periodontal maintenance. These are covered at 100%.
What kinds of services are basic?
Basic services include fillings, simple extractions, some non-surgical gum treatment, certain oral surgery, and certain repairs or miscellaneous services. These are covered at 80%.
What kinds of services are major?
Major services include crowns, bridges, implants, dentures, root canals, surgical extractions, certain surgical gum services, and some repairs. These are covered at 50%.
How does orthodontic coverage work?
Orthodontic services are covered at 50% for children up to age 19, subject to the orthodontic lifetime maximum.
What is a pretreatment estimate, and should I ask for one?
A pretreatment estimate gives you a preview of how the plan may process a larger claim. It can be very helpful before crowns, implants, bridges, dentures, orthodontia, or other costly services.
How do implants work under the plan?
Implants are listed under major services and are covered at 50%, subject to deductible and annual maximum rules. Because implants can be costly, a pretreatment estimate is especially important.
How do crowns work under the plan?
Crowns are listed under major restorative services and are covered at 50%, subject to deductible and annual maximum rules.
What if I may need root canal treatment?
Root canals are listed under major services and are covered at 50%. If a crown may also be needed, ask the office to help estimate the full course of treatment, not just one procedure.
Can treatment be split across calendar years?
Sometimes. If you are close to your annual maximum, ask the office whether treatment timing matters and whether some services can reasonably be phased.
Annual maximums, deductibles, and planning ahead
What is the deductible, and when does it apply?
The deductible is $50 per person, up to $150 per family, each calendar year. It does not apply to preventive services or certain listed categories like orthodontia.
What is the difference between the base and enhanced annual maximum?
The base plan has a $1,000 annual maximum. The enhanced plan increases that amount to $2,000.
Why does the annual maximum matter so much?
Once you reach the annual maximum, the plan stops paying additional covered claims for the rest of the calendar year. That makes treatment timing and pretreatment estimates more important when major services are involved.
How do I know how much annual maximum I have left?
Use Delta’s member tools to review claims and see amounts used toward your deductible and annual maximum.
How should I think about the enhanced plan if I expect larger dental work?
If you expect crowns, implants, dentures, bridge work, orthodontia, or other higher-cost care, the higher annual maximum can make the enhanced plan more attractive.
Orthodontia and timing questions
Who is eligible for orthodontic coverage?
Orthodontic services are covered for children up to age 19.
How much does the plan pay for orthodontia?
The plan pays 50%, subject to the orthodontic lifetime maximum.
What is the orthodontic lifetime maximum under the enhanced plan?
The enhanced plan includes a $2,000 lifetime maximum for orthodontia.
Should I ask for a pretreatment estimate before starting braces?
Yes. Orthodontia is one of the clearest cases where it helps to know up front how the claim is expected to process.
Claims, bills, and paying for care
Why did I get a bill if I have dental insurance?
Dental plans usually share the cost of care rather than cover everything in full. You may owe your deductible, your coinsurance share, or anything above the annual maximum.
What should I do before I pay a larger dental bill?
Compare the office bill to the claim detail or EOB, confirm the provider was processed correctly, and call the office if something does not line up.
Can I use my HSA or FSA for dental costs?
Yes, eligible out-of-pocket dental expenses can generally be paid with HSA or FSA funds.
What if I think a claim was processed incorrectly?
Start with Delta Dental’s claim detail and the dental office’s billing office. If you still are not sure what happened, contact the Benefits team.
What if my office bill seems higher than I expected from the estimate?
Ask the office whether the treatment changed, whether more services were performed than originally planned, or whether something processed differently than expected.
Travel and out-of-country care
What should I do if I need dental care outside the United States?
If it is not urgent, contact Delta before care when possible and ask how to handle out-of-country claims. If care is urgent, focus on getting the care you need and keep detailed receipts and records for follow-up.
What records should I keep for out-of-country dental care?
Keep itemized bills, payment receipts, dates of service, provider information, treatment notes if available, and anything else that shows what care was provided and what you paid.
Will I have a participating network outside the country?
You should not assume that the same network structure will apply outside the United States. Contact Delta if you can before care, and be prepared for reimbursement-style follow-up if needed.
Who should I contact if I need help after returning home?
Start with Delta Dental for claim handling questions, then contact the Benefits team if you need help understanding next steps or the documentation that may be needed.

Need help?

If you are not sure how a dental service may be covered, whether treatment timing matters, or what to do with a bill or claim, please reach out.