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High and Low Dental Plans

Palmetto Health’s dental plans, which are administered by Delta Dental, promote oral health by covering customary charges with no deductible. Keep in mind that preventive services do apply towards your annual maximum allowance per individual each year.  You can maximize your benefits when using Delta Dental’s PPO or Delta Dental’s Premier network of providers.

The following chart is only an overview. You should refer to your Summary Plan Description for any exclusions or limitations that may apply to the specific benefits.

    HIGH   LOW 
  Palmetto Health-USC Dentistry In-Network* Delta PPO & Delta Premier Out of Network** Palmetto Health-USC Dentistry In-Network* Delta PPO & Delta Premier Out of Network**
DEDUCTIBLE $0 $15 $25 $0 $50 $75
MAXIMUM ALLOWABLE BENEFIT $1,500 $1,500 $1,000 $750 $750 $500
PREVENTIVE SERVICES 100% no Deductible 100% no Deductible 100% no Deductible 100% no Deductible 100% no Deductible 100% no Deductible
- Oral examinations and routine cleaning of teeth limited to two per year
- Fluoride treatments, for dependents under age 18, limited to two per year
- Space maintainers for dependent children under age 18
- Emergency treatment to relieve pain
BASIC SERVICES 90%, after Deductible 80%, after Deductible 80%, after Deductible 70%, after Deductible 50%, after Deductible 50%, after Deductible

- Simple extractions (removal) of teeth
- Oral surgery (including impacted third molars)
- Hemi-section- Apicoectomy (cutting of the apex of a tooth root)
- Medically necessary services of an assistant surgeon- Surgical periodontic examination 

MAJOR SERVICES 80%, after Deductible 60%, after Deductible 60%, after Deductible 65%, after Deductible 50%, after Deductible 50%, after Deductible
- Fixed bridgework, partial or full dentures
- Inlays, onlays and crowns      
Orthodontic Deductible – Per Individual n/a $0 $50 n/a n/a n/a
ORTHODONTIC SERVICES not covered 50% with $2,500 lifetime max 50% with $2,000 lifetime max not covered not covered not covered

Your Bi-weekly Dental Premiums

Tier

High DPPO (Palmetto Health)

Low DPPO (Palmetto Health)

TM Only

$12.24

$7.14

TM+Spouse

$21.42

$12.24

TM+Child(ren)

$24.48

$13.26

TM+Family

$39.78

$20.40  

* No balance billing when using the Delta Dental PPO network or the Delta Dental Premier network.
** Coinsurance is based on a percent of usual and customary fees

Find a Dentist

You can use the Palmetto Health-USC Dentistry or find a network dentist through the Delta Dental provider directory: www.DeltaDentalSC.com (choose PPO or Premier network)

Using Palmetto Health-USC Dentistry

Palmetto Health-USC Dentistry is a comprehensive dental facility that offers preventative, specialty and cosmetic dentistry for Palmetto Health team members and the community. The dental center is accepting new patients five years old and older.

10 Richland Medical Park Dr., Suite A, Columbia, SC 29203
Phone: 803-434-6567
Fax: 803-434-6299

Hours of Operation

Monday-Thursday, 7:30 a.m.-4:30 p.m.
Friday, 7:30 a.m.-12:30 p.m.

Appointments

To make an appointment, please call us at 803-434-6567. Please provide 48 business hours’ notice if cancelling an appointment.

Services provided include:

  • Complete General Dentistry – cleanings, fillings, etc.
  • Specialty Dentistry – root canals, porcelain crowns, bridges, etc.
  • Cosmetic Dentistry – tooth whitening, porcelain veneers, etc.
  • Dental Implant Placement
    • Implant Restoration
  • Complete and Partial Denture Prostheses
    • Dentures
    • Oral Surgery (including wisdom teeth)
  • Lasers for Soft Tissue Surgery (less post-operative pain and shorter healing time)
  • Digital Radiology

Related Links

Enrollment Information

New Benefits for 2018

Have a Question?
Contact the Total Rewards Benefits Center at 800-963-3456 or 803-296-8893, or email TotalRewards
@PalmettoHealth.org