UT SELECT Dental Plan

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

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

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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