DENTAL Plan
The Delta Dental PPO plan is a preferred provider organization (PPO) plan. It lets you choose any licensed dentist — in or out of network. When you use a Delta Dental network dentist, you lower your out-of-pocket costs because the network dentists have agreed to charge lower fees while your plan’s in-network services cover a larger share of the charges.
You don’t need to have a primary care dentist or get referrals. Just use Delta Dental online directory at www1.deltadentalins.com to find dentists or specialists. If you choose to use a dentist who doesn’t participate in the network, your out-of-pocket costs will be higher, and you are subject to any charges beyond Reasonable and Customary (R&C).
FIND A NETWORK DENTIST
ADVANTAGE 400 (DPPO) |
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|---|---|---|
| Plan Feature | In Network | Out of Network |
| Benefit Period Maximum | ||
| Deductible | $50 per person $150 per family maximum | $50 per person $150 per family maximum |
| Diagnostic & Preventive Services | No charge | No charge |
| Basic Services | 80% | 80% of Usual and Customary |
| Major Services | 50% | 50% of Usual and Customary |
| Orthodontia | Not covered | |
| Member Perks for your smile and beyond | Your Delta Dental membership does more than help keep your smile bright and healthy when you visit the dentist. Your plan also brings exclusive product discounts, resources, and more to support a healthy lifestyle for your smile and beyond. Ready to make the most of your membership? To get started visit deltadentalins.com/memberperks.html |
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| ENROLLMENT TIER | EE MONTHLY CONTRIBUTIONS | EE BI-WEEKLY CONTRIBUTIONS |
| Employee Only | $10.04 | $4.63 |
| Employee & Spouse | $26.88 | $12.41 |
| Employee & Child(ren) | $22.32 | $10.30 |
| Employee & Family | $48.88 | $22.56 |
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