Employee Benefit Trust

Delta Dental rates

Plan descriptions

Dental

	2024 rate	2025 rate	% Increase from 2024
Plan A
Employee	53.82	53.82	0
Employee + 1 dependent	102.20	102.20	0
Employee + 2 or more dependents	161.42	161.42	0
Plan B
Employee	47.44	47.44	0
Employee + 1 dependent	88.26	88.26	0
Employee + 2 or more dependents	145.48	145.48	0
Plan C
Employee	38.78	38.78	0
Employee + 1 dependent	74.68	74.68	0
Employee + 2 or more dependents	122.10	122.10	0
Plan D
Employee	49.96	49.96	0
Employee + 1 dependent	105.46	105.46	0
Employee + 2 or more dependents	156.14	156.14	0
Plan E
Employee	49.66	49.66	0
Employee + 1 dependent	92.32	92.32	0
Employee + 2 or more dependents	151.82	151.82	0
Plan F
Employee	55.88	55.88	0
Employee + 1 dependent	105.68	105.68	0
Employee + 2 or more dependents	165.42	165.42	0
Plan G
Employee	54.72	54.72	0
Employee + 1 dependent	103.52	103.52	0
Employee + 2 or more dependents	171.12	171.12	0
Plan J
Employee	57.78	57.78	0
Employee + 1 dependent	109.28	109.28	0
Employee + 2 or more dependents	171.06	171.06	0

Orthodontia

	2024 rate	2025 rate	% Increase from 2024
Plan I
Employee	.00	.00	0
Employee + 1 dependent	.16	.16	0
Employee + 2 or more dependents	9.88	9.88	0
Plan II
Employee	.00	.00	0
Employee + 1 dependent	.42	.42	0
Employee + 2 or more dependents	19.74	19.74	0
Plan III
Employee	1.26	1.26	0
Employee + 1 dependent	3.12	3.12	0
Employee + 2 or more dependents	22.22	22.22	0
Plan IV
Employee	.00	.00	0
Employee + 1 dependent	1.06	1.06	0
Employee + 2 or more dependents	35.44	35.44	0
Plan V
Employee	2.50	2.50	0
Employee + 1 dependent	5.80	5.80	0
Employee + 2 or more dependents	39.80	39.80	0

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