|
Benefit |
Delta Dental PPO-Network | Out-of-Network*** |
|---|---|---|
|
Calendar Year Deductible (in- and out-of-network combined) |
$25 Per Member $75 Per Family |
$25 Per Member $75 Per Family |
| Annual Plan Maximum | $3,200 Per Member | $3,000 Per Member |
|
Diagnostic/Preventive Services* Routine exams, 3 cleanings, and x-rays |
90% | 90% |
|
Basic Services Fillings, Endodontics (Root Canals), Periodontics (Gum Treatment) |
90% | 90% |
|
Major Services Crowns, Inlays, Onlays, Prosthodontics** (Bridges, Dentures, Implants) |
90% | 90% |
|
Orthodontics Adults and Dependent Children |
50% | 50% |
| Lifetime Orthodontic Maximum | $2,000 Per Member | $2,000 Per Member |
|
*Costs for covered diagnostic and preventive dental services don't accrue against plan year maximums. Routine exams, cleanings, and x-rays are waived from annual plan maximums, having more dollars to use for other needed dental services. **Implant surgical placement and removal and for implant supported prosthetics, including implant repair and re-cementation. Bone graft may or may not be covered. ***When using an out-of-network provider, you will be responsible for any charges over the allowed amount. |
Delta Dental Mobile App
Delta Dental's mobile app gives you access to dentist search, claims and coverage on your mobile device. It even has a toothbrush timer built in to make sure you keep up with your daily oral health routine! Delta Dental's free mobile app can be downloaded to your mobile device from the App Store (Apple) or Google Play
(Android).