UT SELECT Dental Plan

The UT SELECT Dental Plan is a self-funded PPO dental plan allowing you to visit any dentist, although you may pay less out of pocket if you choose a Delta Dental network (DPO or Delta Dental Premier®) dentist.

Benefits and Covered Services1 UT SELECT Dental2
Deductible $25
Maximums (Each plan year) $1,250
Diagnostic & Preventive Services (D&P) (Exams, cleanings, x-rays, sealants) 100%
Basic Services (Fillings, stainless steel crowns) 80%
Major Services (Crowns, inlays, onlays and cast restorations, bridges and dentures) 50%
Endodontics (Root canals covered Under Basic Services) 80%
Oral Surgery (Covered Under Basic Services) 80%
Periodontics (Periodontal scaling, Root planning, and treatment of gum disease. Covered Under Basic Services 80%
Orthodontic Benefits Adults and dependent children 50%
Orthodontic Maximums (Lifetime) $1,250

1 Limitations may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental contract allowances and not necessarily each dentist’s actual fees.

2 Fees are based on DPO contracted fees for DPO dentists, Premier contracted fees for Premier dentists, and Premier contracted fees for non-Delta Dental dentists.

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