2022-2023 Dental Benefits | Office of Student Health Benefits

Network and claims administration services for the Student Dental Plans are provided by Delta Dental of Minnesota.

Coverage Dates & Plan Highlights

Dental Plan	Who’s Eligible	Plan Highlights
Preventive and Periodontal Dental Plan	All primary members (students) enrolled in the Student Health Benefit Plan	Included in the cost of the Student Health Benefit Plan Preventive dental benefits, covered at 100% once every six (6) months, includes services such as teeth cleanings, x-rays, and comprehensive exams Non-surgical periodontal coverage, covered at 80%, includes deep cleanings
Optional Student Dental Buy-Up Plan	All primary members (students) enrolled in the Student Health Benefit Plan	Additional cost of $839.16 per year. For students who are enrolled in both the fall and spring semesters, the premium will be billed in two installments of $419.58. Restorative dental benefits, covered between 50-80%, includes services such as emergency treatment, fillings, and tooth removal
Pediatric Dental Plan	All primary members (students) up to the age of 19, as well as dependent children up to the age of 19	Included in the cost of the Student Health Benefit Plan for eligible enrollees Preventive and periodontal dental benefits, covered at 100% once every six (6) months, includes services such as teeth cleanings, deep cleanings, x-rays, and comprehensive exams Restorative dental benefits, covered between 50-80%, includes services such as emergency treatment, fillings, and tooth removal

Enrollment

Preventive and periodontal dental benefits are included in the Student Health Benefit Plan (SHBP) for primary members (students) and pediatric members (under age 19). Students are automatically enrolled in the Preventive and Periodontics Plan or Pediatric Plan. The Preventive and Periodontics Plan includes coverage for cleaning and x-rays, but not for restorative services such as fillings, tooth removal, and emergency treatment. Preventative services are covered at no out-of-pocket cost once every six (6) months.

If you would like restorative dental benefits (for services such as fillings and tooth removal), you can enroll in the optional Dental Buy-Up Plan for an additional fee. The start date for restorative dental benefits for the Spring 2023 semester is February 1 and continues through August 31, 2023. To enroll, fill out the online enrollment form or submit an enrollment form to the Office of Student Health benefits by February 2, 2023. Students who were eligible in the fall semester and are joining the Dental Buy-Up Plan for the spring semester will be billed $839.16. Students who are newly eligible for the spring semester will be billed $419.58.

The Dental Buy-Up Plan is not available to International Scholars.

Brochures and Forms

Student Dental Plans Enrollment Brochure
Preventive and Periodontal Plan Summary of Benefits (included in SHBP for primary members)
Optional Dental Buy-Up Plan Summary of Benefits
Pediatric Dental Plan Summary of Benefits
Online enrollment form or PDF Enrollment Form

The full summary of benefits for the Student Dental Plans can be found on the Forms, Brochures & ID Cards tab.

Contact

If you have questions on eligibility, enrollment, or billing, contact:

Office of Student Health Benefits
612-624-0627 or 1-800-232-9017
[email protected]

If you have questions on benefits, coverage and services, in-network providers, or claims, contact:

Delta Dental of Minnesota
Customer Service
651-406-5916 or 800-553-9536 (toll-free)
Monday-Friday, 7 a.m.-7 p.m. CST