Dental Plan Options

Delta Dental is offered through two networks—Delta Dental PPO and Delta Dental Premier®. You can go to any licensed dentist regardless of whether your dentist participates in the Delta Dental network. However, you will receive the most value and maximize your savings by choosing a dentist in the Delta Dental PPO network. The benefits under each option are summarized below.

Dental Benefits are not available to retired participants.

 

Benefits

Delta Dental PPO

Dentists**

Delta Dental Premier Dentists**

Non-Delta Dental

Dentists**

Deductibles

Per member each calendar year

No Deductible No Deductible No Deductible

Maximums (includes all covered services including Diagnostic and Preventive services)

Per member each calendar year

$1,750 $1,750 $1,750

 

 

Covered Services * Delta Dental PPO Dentists** Delta Dental Premier Dentists**     Non-Delta Dental Dentists**
Diagnostic & Preventive Services (D&P) Exams, Cleanings and X-Rays 100% 100% 100%
Basic Services 85% 75% 50%
Covered Services * Delta Dental PPO Dentists** Delta Dental Premier Dentists** Non-Delta Dental Dentists**
Fillings, Sealants, Space Maintainers, Simple Extractions and Posterior Composites
Endodontics
Root Canals
85% 75% 50%

Periodontics

Surgical and Non-Surgical Periodontics

85% 75% 50%
Oral Surgery 85% 75% 50%

Major Services

Crowns, Inlays, Onlays and Cast Restorations

80% 70% 50%

Prosthodontics

Bridges, Dentures and Denture Repair/Reline/Rebase

80% 70% 50%
Temporomandibular Joint (TMJ) Services 85% 75% 50%
TMJ Lifetime Maximum $2,000 $2,000 $2,000
Orthodontic Services
Dependent Children
50% 50% 50%
Orthodontic Lifetime Maximum $1,500 $1,500 $1,500

 

* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees.

** The coinsurance shown here reflects your cost-sharing responsibility. Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists.

Delta Dental Network

The Delta Dental network allows you to maximize your benefits and pay less out of pocket by seeing a Delta Dental PPO dentist. These dentists have agreed to reduced fees, and you won’t get charged more than your expected share of the bill. If you can’t find a PPO dentist, your next best option is to go to a Delta Dental Premier® dentist. These dentists have agreed to set fees and offer another opportunity to save. Your out-of-pocket costs will be higher if you choose an out-of-network (non-Delta Dental) dentist because they can balance bill you for the difference between their submitted fees and the Allowed Amount.

Delta Dental Resources

Welcome to Delta Dental!

Benefit Highlights

Make the most of your Dental Plan

Manage your plan Online

Web-mobile Resources

Delta Dental Online Resources

Get to know the Delta Dental PPO and Premier networks