EHB-Compliant Pediatric Dental Plans

Standard Dental Plans

Delta Dental PPO+Premier EHB Standard
Delta Dental PPO+Premier EHB Enhanced
Delta Dental Premier Family Enhanced
Delta Dental Premier Family Value
Delta Dental EPO Family Enhanced
Delta Dental EPO Family Value

Limited Dental Plans

Delta Dental Adult Pediatric
Delta Dental PPO Pediatric
Delta Dental EPO Pediatric
Delta Dental EPO Pediatric Exclusive Network
Delta Dental EPO Pediatric Basic

Eligible Companies
   PPO+Premier EHB Standard and Enhanced Plans available to groups of 2 or more.
   All others available to individuals and Massachusetts firms with 1 or more eligible employees enrolling
   who maintains a membership with HSA

Eligible Employees
   All full time employees working a minimum of 20 hrs per week

Waiver
   Employees covered through a spousal dental plan may be excluded. A waiver form must be completed

Participation Requirement
   70% of the eligible employees must be enrolled.

Plan Selection for Standard Plans
   All employees must select the same plan. Cannot mix and match plans.

Plan Selection for Limited Plans
   All Children under 19 must select the same plan. All adults must select the Adult Pediatric Plan

Employer Contribution
   The employer must contribute at least 50% of the premium.

New Hires
   All newly hired employees must be enrolled within time frame consistent with company policy.

Non-EHB Compliant Group Plans

Delta Dental PPO + Premier (Non EHB)
Delta Dental Care

Eligible Companies
   A Massachusetts firm with 2 or more eligible employees enrolling who maintains a membership with HSA

Eligible Employees
   All full time employees working a minimum of 30 hrs per week

Waiver
   Employees covered through a spousal dental plan may be excluded. A waiver form must be completed        showing proof of coverage

Participation Requirement
   70% of the eligible employees must be enrolled.

Employer Contribution
   The employer must contribute at least 50% of the premium.

New Hires
    All newly hired employees must be enrolled the first of the month following 30 days of continuous      
   employment or a time frame consistent with company policy.

Non-EHB Compliant Voluntary Plans

Delta Dental PPO Value
Delta Dental Premier Voluntary Option 1
Delta Dental Premier Voluntary Option 2

Eligible Companies
   A Massachusetts firm that maintains a membership with HSA.

Eligible Employees
   All full time employees working a minimum of 20 hrs per week.

Participation Requirement
   There is no participation requirement. This plan is voluntary.

Employer Contribution
   There is no employer contribution requirement

New Hires
    A newly hired employee may enroll the first of any month