Dental coverage options
Dental benefits
Below is a summary of typical dental plan benefits. With the Delta Dental options, you can generally receive the most cost-effective care by using network providers, but you have the flexibility to choose non-participating dentists.* However, for the DMO plans (where availabe), benefits are only available when you receive care from participating providers. Please contact the DMOs directly for detailed plan information and to locate providers.
Coverage option
Delta Dental Premier Basic Plus*
Delta Dental PPO High*
Aetna Dental (DMO)
Cigna Dental Health (DMO)
Availability
Nationwide
Nationwide
Offered in certain geographies only
Offered in certain geographies only
Diagnostic and preventive services
Periodic oral exams, routine teeth cleanings and x-rays**
◄ Covered 100% ►
Basic services
Deductible (combined with major services)
Individual: $50
Family: $150
Individual: $50
Family: $150
None
None
Fillings
You pay 50%
You pay:
- 20% PPO dentist
- 50% other dentists
Covered 100% (alternative resin benefit may apply)
Covered 100% ($47 copay applies for posterior resin)
Root canals
You pay 50%
You pay:
- 20% PPO dentist
- 50% other dentists
You pay $50 to $150 depending on tooth
You pay:
- $12 anterior
- $31 bicuspid
- $280 molar
Extractions
You pay 50%
You pay:
- 20% PPO dentist
- 50% other dentists
Covered 100% (if uncomplicated)
You pay $12
Major services***
Deductible (combined with basic services)
Individual: $50
Family: $150
Individual: $50
Family: $150
None
None
Crowns
You pay 50%
You pay:
- 20% PPO dentist
- 50% other dentists
You pay $185 (full cast noble metal with prior authorization)
You pay:
- $335 base metal
- $380 high noble
- $355 noble metal
Bridges
You pay 50%
You pay:
- 40% PPO dentist
- 50% other dentists
Costs vary (see carrier summary or contact Aetna)
Costs vary (see carrier summary or contact Cigna)
Dentures
You pay 50%
You pay:
- 40% PPO dentist
- 50% other dentists
Costs vary (see carrier summary or contact Aetna)
Costs vary (see carrier summary or contact Cigna)
Orthodontic services
Child
Not covered
You pay 50% (lifetime maximum benefit of $1,500 per person)
You pay $1,000 (24-month treatment; not all-inclusive)****
You pay $1,584 (24-month treatment; added fees may apply for banding and removal)
Adult
Not covered
You pay 50% (lifetime maximum benefit of $1,500 per person)
You pay $1,000 (24-month treatment; not all-inclusive)****
You pay $2,328 (24-month treatment; added fees may apply for banding and removal)
Annual maximum benefit
Amount for each covered individual
$750
$1,500
None
None
Additional details
Contact information and apps
* Under the Delta Dental options, if you go to a nonparticipating dentist, your actual payment may be higher because you will be subject to balance billing if your dentist charges more than Delta’s allowable amount. See the Dental Assistance Plan SPD at www.dowbenefits.com for an example.
** Under the Delta Dental options, bitewing x-rays are payable once per calendar year for members under age 15 and once in any two calendar years for people age 15 and older. Full mouth x-rays are payable once in any five-year period.
*** Under the DMOs, copayments may vary depending on the tooth being serviced.
**** Under the Aetna DMO fixed copayment plan, interceptive orthodontia (phase I) is not a covered procedure. Usually, this service is performed first to see if the problem can be corrected. If the problem is corrected, then comprehensive orthodontia (phase II) may not be needed.
Delta Dental Premier Basic Plus*
- Availability: Nationwide
Diagnostic and preventive services
- Periodic oral exams, routine teeth cleanings and x-rays**: Covered 100%
Basic services
- Deductible (combined with major services): Individual: $50 | Family: $150
- Fillings: You pay 50%
- Root canals: You pay 50%
- Extractions: You pay 50%
Major services
- Deductible (combined with basic services): Individual: $50 | Family: $150
- Crowns: You pay 50%
- Bridges: You pay 50%
- Dentures: You pay 50%
Orthodontic services
- Child: Not covered
- Adult: Not covered
Annual maximum benefit
- Amount for each covered individual: $750
Additional details
- Review the detailed carrier summary: Delta Dental Premier Basic Plus Benefit Summary
- Contact information and apps: deltadentalmi.com | (800) 524-0149 | Apple App Store | Google Play
Delta Dental PPO High*
- Availability: Nationwide
Diagnostic and preventive services
- Periodic oral exams, routine teeth cleanings and x-rays**: Covered 100%
Basic services
- Deductible (combined with major services): Individual: $50 | Family: $150
- Fillings: You pay 20% PPO dentist | 50% other dentists
- Root canals: You pay 20% PPO dentist | 50% other dentists
- Extractions: You pay 20% PPO dentist | 50% other dentists
Major services
- Deductible (combined with basic services): Individual: $50 | Family: $150
- Crowns: You pay 20% PPO dentist | 50% other dentists
- Bridges: You pay 40% PPO dentist | 50% other dentists
- Dentures: You pay 40% PPO dentist | 50% other dentists
Orthodontic services
- Child: You pay 50% (lifetime maximum benefit of $1,500 per person)
- Adult: You pay 50% (lifetime maximum benefit of $1,500 per person)
Annual maximum benefit
- Amount for each covered individual: $1,500
Additional details
- Review the detailed carrier summary: Delta Dental PPO High Benefit Summary
- Contact information and apps: deltadentalmi.com | (800) 524-0149 | Apple App Store | Google Play
Aetna Dental (DMO)
- Availability: Offered in certain geographies only
Diagnostic and preventive services
- Periodic oral exams, routine teeth cleanings and x-rays**: Covered 100%
Basic services
- Deductible (combined with major services): None
- Fillings: Covered 100% (alternative resin benefit may apply)
- Root canals: You pay $50 to $150 depending on tooth
- Extractions: Covered 100% (if uncomplicated)
Major services
- Deductible (combined with basic services): None
- Crowns: You pay $185 (full cast noble metal with prior authorization)
- Bridges: Costs vary (see carrier summary below or contact Aetna)
- Dentures: Costs vary (see carrier summary below or contact Aetna)
- Orthodontic services
- Child: You pay $1,000 (24-month treatment; not all-inclusive)****
- Adult: You pay $1,000 (24-month treatment; not all-inclusive)****
Annual maximum benefit
- Amount for each covered individual: None
Additional details
- Review the detailed carrier summary: Aetna Dental (DMO) Benefit Summary
- Contact information and apps: aetna.com | (877) 238-6200 | Apple App Store | Google Play
Cigna Dental Health (DMO)
- Availability: Offered in certain geographies only
Diagnostic and preventive services
- Periodic oral exams, routine teeth cleanings and x-rays**: Covered 100%
Basic services
- Deductible (combined with major services): None
- Fillings: Covered 100% ($47 copay applies for posterior resin)
- Root canals: You pay $12 anterior | $31 bicuspid | $280 molar
- Extractions: You pay $12
Major services
- Deductible (combined with basic services): None
- Crowns: You pay $335 base metal | $380 high noble | $355 noble metal
- Bridges: Costs vary (see carrier summary below or contact Cigna)
- Dentures: Costs vary (see carrier summary below or contact Cigna)
Orthodontic services
- Child: You pay $1,584 (24-month treatment; added fees may apply for banding and removal)
- Adult: You pay $2,328 (24-month treatment; added fees may apply for banding and removal)
Annual maximum benefit
- Amount for each covered individual: None
Additional details
- Review the detailed carrier summary: Cigna Dental Health (DMO) Benefit Summary
- Contact information and apps: cigna.com | (800) 244-6224 | Apple App Store | Google Play
Contributions (monthly amounts for 2026)
The amount you pay to have dental coverage depends on your plan and coverage tier
The brief summaries of benefits in this communication are not intended to be complete descriptions of each of the respective benefit plans. If there are discrepancies between (a) information in this communication and any oral or written representations made by anyone regarding a plan and (b) the Summary Plan Descriptions (SPD) and other legal documents of any of the plans, the SPD and other legal documents will govern. Dow reserves the right to amend, modify, and terminate the plans described in this communication at any time in its sole discretion.
Content Steward: Dow North America Benefits | (833) 693-6947 (MYDOWHR)
October 2025