Dental Insurance

Dental insurance through SEHP includes:

  • 100% coverage for 2 exams/cleaning + annual x-rays per person, per plan year
  • Enhanced benefit for restorative services with annual exam/cleaning (annual benefit maximum of $1,700)
  • Orthodontic coverage up to $1,000 per person lifetime maximum

It is the employee's responsibility to make any changes to their insurance plans during Open Enrollment, or if they experience a qualifying event such as birth of a child, adoption, loss/gain of coverage, etc. You have 30 days to provide documentation if you experience an event that changes the status of your health benefits.

To check your dental insurance benefit, or to update your information with your insurance providers, log into SEHP Member Administration Portal (MAP). 

Provider Networks

SEHP dental coverage is provided by Delta Dental. Delta Dental offers two distinct provider networks:

Delta Dental PPO Network

The PPO Network Providers have agreed to a reduced fee for providing dental services. As a result, you generally pay a lower percentage of the total bill than you would when using a Premier (or Non Network) Provider. The PPO network for our group includes all PPO providers in the national DeltaUSA PPO network. Participants have the option to use the PPO providers whenever desired.

Delta Dental Premier Network

Delta Premier Dentists agree to accept the plan allowance as payment in full. Costs for services provided by Premier Network Providers may have higher out-of-pocket costs for members.

Covered Services

This is a limited benefit policy. Plan benefits are limited to the specific listed services and include limitations on specific age and service frequency. Service frequency is measured from the date of the last service supplied to the member whether or not this plan was effective at the time of the service.

Your Coinsurance will increase for Basic Restorative Services when You have not had a routine prophylaxis (cleaning) and/or preventive oral exam in the preceding twelve (12) month period. Ninety (90) days following receipt of a qualifying prophylaxis (cleaning) or preventive oral exam, You will qualify for the Enhanced Benefit Level. The Plan reserves the right to determine what services will qualify as meeting the definition of a routine prophylaxis (cleaning) and preventive oral exam.

Preventive Services

The following services are considered Preventive Services by the Plan. Preventive services are not subject to the Annual Benefit Maximum.

  • Routine Oral Examinations Include
    • Covered twice (2) per Member per Plan Year
    • Bitewing x-rays
      • A set is four (4) bitewing x-rays
      • Covered in conjunction with oral exam and/or prophylaxis
      • Two (2) sets of bitewings per Plan Year for Members to age eighteen (18)
      • One (1) set of bitewings per Plan Year for Members age eighteen (18) and over

Basic Restorative Dentistry

  • Fillings: Provides for amalgam (silver) restorations; composite (white) resin restorations; and stainless steel crowns for dependents under age twelve (12).
  • Accidental Injuries: Office visits and x-rays that may be required for diagnosis or treatment of accidental injuries to the teeth when not provided as a part of a routine oral exam or prophylaxis.
  • Oral Surgery: Provides for extractions and related oral surgical procedures performed by the dentist including pre- and post-operative care.
  • Endodontics: Includes procedures for root canal treatments and root canal fillings.
  • Periodontics: Includes procedures for the treatment of diseases of the gums and bone supporting the teeth.

Major Restorative Dentistry

  • Crowns: When teeth cannot be restored with a filling material listed in Basic Restorative Dentistry, provides for gold restorations and individual crowns.
  • Prosthodontics: Bridges, implants (pre-determination of implants is recommended), partial and complete dentures, including repairs and adjustments.
  • Temporomandibular Joint Dysfunction: Treatment plan must be pre-authorized by Delta Dental. Treatment is limited to specific non-surgical procedures involving Temporomandibular Joint Dysfunction.

More Information