Dental
Dental coverage helps you maintain a healthy smile with preventive care, basic services, and major procedures. You can visit any licensed dentist, but you’ll save the most when you use an in-network provider who has agreed to discounted rates. Out-of-network dentists may charge more than the plan’s allowed amount, and you may be responsible for the difference. Most plans cover preventive services—such as exams, cleanings, and X-rays—at 100% when you stay in-network, making regular checkups an easy way to protect your oral health and avoid costly issues.
Contact
Delta Dental
Policy #1121
800-765-6003
deltadentalins.com
Delta Dental Core PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0
Annual Plan Max (Per Individual)
$2,000
Preventive Care
No charge
Basic Services
10%
Major Procedures
10%
Orthodontia (Adults and Children)
10% up to a lifetime maximum benefit of $1,000
Out-of-Network
Deductible (Individual/Family)
$0
Annual Plan Max (Per Individual)
$2,000
Preventive Care
10%
Basic Services
10%
Major Procedures
10%
Orthodontia (Adults and Children)
10% up to a lifetime maximum benefit of $1,000
Per Pay Period Plan Cost
Employee Only: $0
Employee and Spouse: $0
Employee and Child(ren): $0
Employee and Family: $0
Delta Dental Choice PPO
Benefit Highlights
In-Network
Deductible (Per Individual)
$2,000
Annual Plan Max (Individual/Family)
$XX/$XX
Preventive Care
No charge
Basic Services
Nor charge
Major Procedures
10%
Orthodontia (Adults and Children)
10% up to a lifetime maximum benefit of $2,500 per individual
Out-of-Network
Deductible (Per Individual)
$2,000
Annual Plan Max (Individual/Family)
$XX/$XX
Preventive Care
No charge
Basic Services
10%
Major Procedures
10%
Orthodontia (Adults and Children)
10% up to a lifetime maximum benefit of $2,500 per individual
Per Pay Period Plan Cost
Employee Only: $13.85
Employee and Spouse: $25.38
Employee and Child(ren): $34.62
Employee and Family: $46.15