Dental Coverage
Dental Plan Overview
St. Cloud State University offers dental coverage to benefit-eligible employees through the State Employee Group Insurance Program (SEGIP).
Administered by Delta Dental Group 216 and Health Partners, these plans provide extensive benefits to support a wide range of dental care needs. This may include coverage for preventive, diagnostic, and treatment services, as well as basic and major restorative care. Orthodontic services for adults and children may also be available, subject to plan limitations and lifetime maximums. Employees can choose to enroll themselves and eligible family members, including a spouse, children, and dependents.
Both dental plan options offer similar benefits, including the same annual maximum. However, there are differences in how certain benefits are administered. Similar to health insurance providers, dental insurance carriers may not be available in every county throughout the state.
For more details, refer to the links below.
Additional Information
Schedule of Benefits Overview
Eligibility & Administration
Dental coverage is available to benefit-eligible employees through the State Employee Group Insurance Program (SEGIP). Plans are administered by Delta Dental and HealthPartners.
Coverage Highlights
Dental plans typically include coverage for:
- Preventive and Diagnostic Care: Services such as exams, cleanings, fluoride treatments, sealants, and space maintainers are generally covered at a high percentage when using in-network providers.
- Restorative and Prosthetic Services: Includes fillings, crowns, oral surgery, periodontal and endodontic treatments, implants, dentures, and bridgework. These services are usually subject to a deductible and coinsurance.
- Orthodontic Care: Coverage is available for both adults and children, with a lifetime maximum benefit. Coverage levels may vary depending on provider network status.
- Emergency Dental Services: Typically covered at the same benefit level as non-emergency services.
Network Considerations
- In-network providers generally offer higher coverage levels and lower out-of-pocket costs.
- Out-of-network providers may result in reduced coverage and higher costs to the member.
Annual & Lifetime Maximums
- Plans include an annual maximum benefit per person, which does not apply to preventive or orthodontic care.
- Orthodontic services have a separate lifetime maximum that does not reset if you change plans.
See Dental Schedule of Benefits for Health Partners or Delta Dental for specific coverage benefits and plan limitations.
General Overview of State Dental Plan Rates
The State Dental Plan is offered through two plan administrators, with identical monthly premium rates regardless of the administrator selected.
Coverage Options:
- Employee Coverage: Provides dental benefits for the employee only.
- Family Coverage: Includes the employee, spouse, and eligible dependents.
Employer Contribution Levels: Monthly premium rates vary based on the level of employer contribution:
- Full Contribution: The state covers the majority of the premium cost.
- 75% Contribution: The state covers three-quarters of the premium.
- 50% Contribution: The state covers half of the premium.
- No Contribution: The employee is responsible for the full premium cost.
Cost Structure:
- The total monthly premium is split between the employee and the state based on the applicable contribution level.
- The cost to add a spouse and/or dependents is calculated as an additional amount on top of the employee-only coverage.
- Standalone dependent coverage is not available; dependents must be added under family coverage.
Review SEGIP's Dental Plan Rates for specific plan rates and employer contribution amounts.
- Each dental plan has a network of dentists and, in some cases, preferred specialists through which you receive in-network care.
- You can access directories of dental clinics and dentists on your plan administrator’s website
- To ask specific questions about dental clinics, call the plan administrator directly.
When planning for dental procedures beyond routine exams or cleanings, it's important to request a cost estimate in advance. This estimate, provided by your dental insurance, outlines what portion of the treatment will be covered and what your out-of-pocket costs may be.
This process is known by different names depending on your dental provider:
- HealthPartners Dental refers to it as a Predetermination.
- Delta Dental calls it a Pretreatment Estimate of Benefits.
Requesting this estimate before receiving care helps you make informed decisions and avoid unexpected expenses. This process does not prior authorize the treatment, nor does it determine its dental or medical necessity. The estimated payment is based on your current eligibility and contract benefits in effect at the time of the estimate. It is an estimate ONLY.
Go to your HealthPartners Dental or Delta Dental Summary of Benefits to review the rules for coverage.