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Underwritten by
Delta Dental Insurance Company
Delta Dental Defender


Cost breakdown

Monthly Premium


Administration Fee


PEP Benefit
(one time payment)


Initial total cost


Benefits & coverage

Plan Type



$50.00 Individual

Annual Max Benefit


Vision Coverage


Rountine exams (two per benefit year)


Cleanings (two per benefit year)


X-rays (bitewings -2 per benefit year)


Fluoride treatments (once per benefit year to age 16)


Space maintainers (to age 16)


Sealants (to age 16)


X-rays (full mouth-1 per 5 years)


Emergency exams and palliative (pain relief) treatment


Fillings (silver (amalgam) and tooth colored (composite) on front teeth)


Oral surgery (simple extractions)


Sedative fillings


Recementation of bridges, crowns, onlays


Oral surgery (surgical extractions including general anesthesia, IV sedation)

Not Covered

Oral surgery (all other)

Not Covered

Endodontics (root canals and pulpal therapy)

Not Covered

Non-surgical Periodontic (gum) maintenance

Not Covered

Surgical Periodontic (gum) maintenance

Not Covered

Crowns, onlays, and other ceramic restorations to permanent teeth

Not Covered

Partial/full dentures

Not Covered

Denture (repair, reline, rebase and adjustments)

Not Covered

Fixed/removable bridges

Not Covered

Bridge and crown repair

Not Covered

Tissue conditioning

Not Covered

Labial veneers

Not Covered

Major Services Waiting Period

12 months


Dental Limitations & Exclusions


  1. Pulp vitality tests billed in conjunction with any service except for an emergency exam or palliative treatment are not a covered benefit.
  2. Panoramic x-ray for a patient under age 6 is not a covered benefit.


  1. Recementation of a space maintainer within six months of initial placement is not a covered benefit.


  1. Fillings are not a covered benefit when crowns are allowed for the same teeth.
  2. Replacement of any existing cast restoration (crowns, onlays, ceramic restorations) with any type of cast restoration within 84 months following initial placement of existing restoration is not a covered benefit.
  3. Replacement of a stainless-steel crown with any type of cast restoration is not a covered benefit by the same office within 24 months following initial placement.
  4. A cast restoration is a covered benefit only in the presence of radiographic evidence of decay or missing tooth structure. Restorations placed for any other purpose, including, but not limited to, cosmetics, abrasion, attrition, erosion, restoring or altering vertical dimension, congenital or developmental malformations of teeth, or the anticipation of future fractures, are not a covered benefit.
  5. When there is radiographic evidence of sufficient vertical height (more than three millimeters above the crestal bone) on a tooth to support a cast restoration, a crown build-up is not a covered benefit.
  6. The repair of any component of a cast restoration is not a covered benefit.
  7. Recementation of inlays, onlays, partial coverage restorations, cast and prefabricated posts and cores and crowns by the same office within six months of initial placement is not a covered benefit.
  8. Additional procedures to construct a new crown under the existing partial denture framework within six months following initial placement is not a covered benefit.
  9. When a sedative filling is requested or placed on the same date as a permanent filling, the sedative filling is not a covered benefit.
  10. Major restoratives for a patient under age 12 is not a covered benefit.


  1. When a benefit has been issued for endodontic services, retreatment of the same tooth within two years is not a covered benefit.
  2. Endodontic procedures performed in conjunction with complete removable prosthodontic appliances are not a covered benefit.


  1. Guided tissue regeneration billed in conjunction with implantology, ridge augmentation/sinus lift, extractions or Periradicular surgery/apicoectomy is not a covered benefit.
  2. Crown lengthening or gingivoplasty, if not performed at least four weeks prior to crown preparation, is not a covered benefit.
  3. Bone replacement grafts performed in conjunction with extractions or implants are not a covered benefit.
  4. Periodontal splinting to restore occlusion is not a covered benefit.


  1. Replacement of any existing prosthodontic appliance (cast restorations, fixed partial dentures, removable partial dentures, complete denture) with any prosthodontic appliance within 84 months following initial placement of existing appliance is not a covered benefit.
  2. When a fixed partial denture and a removable partial denture are requested or placed in the same arch, the fixed partial denture is not a covered benefit.
  3. Any prosthodontic appliance connected to an implant is not a covered benefit.
  4. Reline or rebase of an existing appliance within six months following initial placement is not a covered benefit.
  5. Fixed or removable prosthodontics for a patient under age 16 is not a covered benefit.
  6. When the edentulous (toothless) space between teeth is less than 50% of the size of the missing tooth, a pontic is not a covered benefit.


  1. Mobilization of an erupted or malpositioned tooth to aid eruption or placement of a device to facilitate eruption of an impacted tooth performed in conjunction with other oral surgery is not a covered benefit.


Coverage is NOT provided for:

  1. Services compensable under Worker’s Compensation or Employer’s Liability laws.
  2. Services provided or paid for by any governmental agency or under any governmental program or law, except as to charges which the person is legally obligated to pay. This exception extends to any benefits provided under the U.S. Social Security Act and its Amendments.
  3. Services performed to correct developmental malformation including, but not limited to, cleft palate, mandibular prognathism, enamel hypoplasia, fluorosis and congenitally missing teeth. This exclusion does not apply to newborn infants.
  4. Services performed for purely cosmetic purposes, including, but not limited to, tooth-colored veneers, bonding, porcelain restorations and microabrasion. Orthodontic care benefits shall fall within this exclusion unless such benefits are provided by endorsement.
  5. Charges for services completed prior to the date the person became covered under this program.
  6. Services for anesthetists or anesthesiologists.
  7. Temporary procedures.
  8. Any procedure requested or performed on a tooth when radiographs indicate that less than 40% of the root is supported by bone.
  9. Services performed on non-functional teeth (second or third molar without an opposing tooth).
  10. Services performed on deciduous (primary) teeth near exfoliation.
  11. Drugs or the administration of drugs, except for general anesthesia and intravenous conscious sedation.
  12. Procedures deemed experimental or investigational by the American Dental Association, for which there is no procedure code, or which are inconsistent with Current Dental Terminology coding and nomenclature.
  13. Services with respect to any disturbance of the temporomandibular joint (jaw joint).
  14. Procedures, techniques or materials related to implantology or edentulous (toothless) ridge enhancement.
  15. Procedures that Delta Dental considers to be included in the fees for other procedures. For such procedures, a separate payment will not be made by this group dental plan. A Dentist in the Delta Dental PPO or Delta Dental Premier network may not bill the patient for such procedures.
  16. The completion of claim forms and submission of required information, not otherwise covered, for determination of benefits.
  17. Infection control procedures and fees associated with compliance with Occupational Safety and Health Administration (OSHA) requirements.
  18. Broken appointments.
  19. Services and supplies for any illness or injury occurring on or after the covered individual’s effective date of coverage as a result of war or an act of war.
  20. Services for, or in connection with, an intentional self-inflicted injury or illness while sane or insane, except when due to domestic violence or a medical (including both physical and mental) health condition.
  21. Services and supplies received from either a covered individual’s or covered individual’s spouse’s relative, any individual who ordinarily resides in the covered individual’s home or any such similar person.
  22. Services for, or in connection with, an injury or illness arising out of the participation in, or in consequence of having participated in, a riot, insurrection or civil disturbance or the commission of a felony.
  23. Charges for services for inpatient/outpatient hospitalization.
  24. Services or supplies for oral hygiene or plaque control programs.
  25. Services or supplies to correct harmful habits.

Frequently Asked Dental Questions

Delta Dental of Illinois plans include coverage for dental treatments in three different levels of benefits, which may be subject to waiting periods or frequency limitations. All levels of benefits are guaranteed issue.

  • Preventative/Diagnostic Services – Examinations, cleanings, fluoride treatments, and x-rays.
  • Basic Services – Emergency treatment of dental pain, restorative work, and simple extractions.
  • Major Services – Surgical extractions, periodontal maintenance, endodontics, and dentures.

Choose the plan level with the coverage that’s right for you.

Delta Dental of Illinois plans are available to people age 18 and older, their spouses/domestic partners, and their dependent unmarried children up to age 26. Disabled dependent children can remain on the policy after age 26.

AFEUSA is a membership organization that provides lifestyle-related benefits to its members. AFEUSA strives to bring the member the most current information on business, technology, and related processes to help the member grow the confidence needed to succeed. The association’s benefits are not insurance and do not provide coverage, they only provide discounts and services and are not affiliated with Delta Dental of Illinois.

Yes, but by staying within the network the chosen dentist cannot charge members the difference between their usual fee and the allowed plan fee (this difference is known as balance billing and can be avoided by staying in-network).

Delta Dental of Illinois provides dental coverage to more than 2 million members nationwide and has the largest national dental networks with 3 out of 4 of all dentists participating in a Delta Dental network nationwide.

The annual maximum benefit is the maximum benefit payable by the policy for all covered procedures completed in the plan year. The maximum varies depending on which plan is chosen.

Deductibles vary by plan level selected and are on a per person basis. A covered person must pay any their deductible amount before covered benefits are payable under the plan chosen.

As long as you go to an in-network dental provider, the plan can be billed and pay network dentists directly so no need to file a claim.

If a covered procedure is started before the benefit waiting period for that procedure ends, that procedure is not covered under the policy. The benefit waiting periods for covered procedures are listed in the Benefits section of the plan brochure.

The percentage of covered expense is the percentage that the plan will pay for a covered procedure. The percentage applicable may vary by covered procedure and is shown in the Benefits section of the plan brochure.

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