Dental Plan

The Quality Care Dental Plan (QCDP) is administered by Delta Dental of Illinois.  Plan participants enrolled in the dental plan can choose any dental provider for services; however, plan participants may pay less out-of-pocket when they receive services from a network dentist. There are two separate networks of dentists that a plan participant may utilize for dental services in addition to out-of-network providers: the Delta Dental PPO^SM network and the Delta Dental Premier^SM network.

As of July 1, 2021, members have the option to elect dental only coverage.  However, the dependents must mirror the coverage that was chosen for the member.

Non-Medicare annuitants and survivors who elect to opt out of the health coverage will continue to have dental coverage under the plan. This benefit of 'no health, keep dental' does not apply to active employees who opt out or annuitants who are not eligible for the financial incentive. Annuitants and survivors who do not want the dental coverage must mark the appropriate box on the Benefit Choice Election Form in order to drop their dental coverage. Note: Opting out of health includes the termination of vision, prescription, and behavioral health coverage.

The annual Benefit Choice Period is the only time members may enroll in the dental plan or waive enrollment. 

The annual plan deductible is $175 per participant per plan year.

After the annual deductible has been met there is a maximum benefit amount for In-Network and Out-of-Network Providers:

In-Network Providers – The annual maximum for all dental services (including child orthodontia) is $2,500.  The lifetime maximum benefit for child orthodontia is $2,000 and is subject to course of treatment limitations. 

Out-of-Network Providers - The annual maximum for all dental services (including child orthodontia) is $2,000. The lifetime maximum benefit for child orthodontia is $1,500.

NOTE: Total benefit reimbursement for all dental services combined may not exceed the maximum benefit level each plan year.

The QCDP reimburses only those services listed on the Dental Schedule of Benefits. Dental procedure codes not listed on the Schedule of Benefits are considered noncovered services and are not eligible for payment. Listed services are reimbursed at a predetermined maximum scheduled amount and members are responsible for any amounts over the scheduled amount.

FY2025 Dental Schedule of Benefits

FY2024 Dental Schedule of Benefits

FY2023 Dental Schedule of Benefits

• Plan participants are responsible for any noncovered services, any amounts over the maximum benefit and the yearly deductible.
• Plan participants may obtain claim forms and identification cards from Delta Dental.
• Most providers will file the dental claim with Delta Dental electronically, but for those who do not, the member must complete a Delta Dental of Illinois Claim form and send to the address on the form.
• The benefit plan year is July 1 through June 30.

Delta Dental recommends that you ask your dentist to submit a pre-treatment estimate for services over $300 so you have an estimate of what you may owe. A pre-treatment estimate of benefits is not a guarantee of benefits.

Preventive and Diagnostic Services include, but are not limited to:

• Two periodic oral examinations per person per plan year.
• Two adult or child prophylaxis (scaling and polishing of teeth) per person per plan year.  (Enhanced Benefits were added during the FY25 Benefit Choice period.  For eligibility requirements members should contact Delta Dental)
• Two bitewing radiographs per person per plan year.
• One full mouth radiograph is covered once in a period of three plan years.

Prosthodontics are subject to the following limitations:

• Prosthodontics to replace missing teeth are covered only for teeth that are lost while the person is covered under this plan.
• Immediate dentures are covered only if five or more teeth are extracted on the same day.
• Permanent dentures to replace immediate dentures are covered only if placed in the person’s mouth within two years from the placement of the immediate denture.
• Replacement dentures are covered only under one of the following circumstances:
  • Existing denture is at least 5 years old, or
  • Structural changes in the person's mouth require new dentures.
• Replacement crowns are covered only when the existing crown is at least 5 years old.
• Replacement bridges are covered only when the existing bridge is at least 5 years old.

The lifetime maximum benefit for child orthodontics is $2,000. The benefit is based on the length of treatment. This lifetime maximum applies to each plan participant regardless of the number of courses of treatment.

• The course of treatment (initial banding) must begin before age 19.
• For a detailed description of your orthodontia dental plan benefits see the:

FY2025 Orthodontia Schedule of Benefits

FY2024 Orthodontia Schedule of Benefits

FY2023 Orthodontia Schedule of Benefits

• For covered orthodontic services contact Delta Dental.
• The plan year deductible will apply to the orthodontic benefit if it is the initial claim processed in a plan year except for preventive or diagnostic procedures.

Reimbursement of Benefit: 25% of the applicable maximum benefit, based on the length of treatment, is reimbursed after the initial banding. The remaining benefit is prorated over the remaining length of treatment.

All claims should be filed promptly. The dental plan administrator requires that all claims be filed no later than one year from the ending date of the plan year in which the charge was incurred.

All communication to Delta Dental must include the member’s social security number (SSN) or alternate member identifier (AMI) and appropriate group number as listed on the identification card. This information must be included on every page of correspondence.

• Complete the Delta Dental of Illinois Claim form.
• How to Submit a Dental Claim | Delta Dental of Illinois (deltadentalil.com)
• Attach the itemized bill from the provider of services to the claim form. The itemized bill must include name of patient, date of service, diagnosis, procedure code and the provider’s name, address and telephone number.
• If the person for whom the claim is being submitted has primary coverage under another group plan or Medicare, the explanation of benefits (EOB) from the other plan must also be attached to the claim.
• The dental plan administrator may communicate directly with the plan participant or the provider of services regarding any additional information that may be needed to process a claim.
• The benefit check will be sent and made payable to the member (not to dependents) unless benefits have been assigned directly to the provider of service.
• If benefits are assigned, the benefit check is made payable to the provider of service and mailed directly to the provider. An EOB is sent to the plan participant to verify the benefit determination.

Connecting with Delta Dental of Illinois is easy!  Use this link as a guide to register through Member Connection. Once registered, you can easily access you and your covered dependents’ benefits and claims information, print a temporary ID card, sign up to receive electronic EOBs (Go Green E-Statements), conduct a procedure code search and access EOB history.

The plan covers eligible charges incurred for services received outside of the United States. All plan benefits are subject to plan provisions and deductibles.

Payment for the services may be required at the time service is provided and a paper claim must be filed with the dental plan administrator. When filing the claim, enclose the itemized bill with a description of the service translated to English and converted to U.S. currency along with the name of the patient, date of service, diagnosis, procedure code and the provider’s name, address, and telephone number.