Dental Benefits

Hormel Foods offers affordable plan options from Delta Dental of MN for routine care and beyond.

Covered Services

	DELTA DENTAL PPO IN-NETWORK	OUT-OF-NETWORK
Annual deductible - Individual	$0	$75
Annual deductible - Family	$0	$150
Annual maximum - Per person	$3,000	$2,500
PREVENTIVE SERVICES Oral Exams, Routine Cleanings, Bitewing X-rays, Panoramic X-rays	90%	80%
BASIC SERVICES Full Mouth X-rays, Fillings, Oral Surgery, Simple Extractions	80%	80%
MAJOR SERVICES Oral Surgery, Complex Extractions, Denture Adjustments and Repairs, Root Canal Therapy, Periodontics, Crowns, Dentures, Bridges	80%	80%
Orthodontics	50%	50%
Orthodontic lifetime maximum	Delta Dental PPO Provider: 50%, up to $3,000 Delta Dental Premier: 50%, up to $2,500	50%, up to $2,500

Annual deductible - Individual

DELTA DENTAL PPO IN-NETWORK$0

OUT-OF-NETWORK$75

Annual deductible - Family

DELTA DENTAL PPO IN-NETWORK$0

OUT-OF-NETWORK$150

Annual maximum - Per person

DELTA DENTAL PPO IN-NETWORK$3,000

OUT-OF-NETWORK$2,500

PREVENTIVE SERVICES Oral Exams, Routine Cleanings, Bitewing X-rays, Panoramic X-rays

DELTA DENTAL PPO IN-NETWORK90%

OUT-OF-NETWORK80%

BASIC SERVICES Full Mouth X-rays, Fillings, Oral Surgery, Simple Extractions

DELTA DENTAL PPO IN-NETWORK80%

OUT-OF-NETWORK80%

MAJOR SERVICES Oral Surgery, Complex Extractions, Denture Adjustments and Repairs, Root Canal Therapy, Periodontics, Crowns, Dentures, Bridges

DELTA DENTAL PPO IN-NETWORK80%

OUT-OF-NETWORK80%

Orthodontics

DELTA DENTAL PPO IN-NETWORK50%

OUT-OF-NETWORK50%

Orthodontic lifetime maximum

DELTA DENTAL PPO IN-NETWORKDelta Dental PPO Provider: 50%, up to $3,000 Delta Dental Premier: 50%, up to $2,500

OUT-OF-NETWORK50%, up to $2,500

After you have satisfied the deductible, if any, the Dental Plan pays the following percentages of the treatment cost, up to a maximum fee per procedure. The maximum fee allowed by Delta Dental is different for Delta Dental PPO™ dentists, Delta Dental Premier® dentists, and nonparticipating dentists. If you see a nonparticipating dentist, your out-of-pocket expenses may increase. If a Delta Dental PPO™ dentist provides dental services, the deductible will be waived and the payment percentages may increase, resulting in lower out-of-pocket costs. To find a network dentist, visit Delta Dental of MN at deltadentalmn.org.
Dental premium contributions are deducted from your paycheck on a pre-tax basis. Your tier of coverage determines your premium.
Preventive services are covered at 90% in-network (80% out-of-network); orthodontics are covered at 50% up to a lifetime maximum of $3,000 with a Delta Dental PPO provider ($2,500 with Delta Dental Premier or out-of-network).