Dental Coverage
The following chart summarizes the Delta Dental benefits for the Dental plan offered to all eligible employees.
Dental PPO Plan
Benefit | In-Network | Out-of-Network |
|---|---|---|
| Annual Deductible (Calendar year) | $150/Family | $300/Family |
| Annual Maximum (Calendar year) | ||
| Preventive & Diagnostic Services | ||
| Oral Exam, X-rays, Cleanings | ||
| Basic Services | ||
| Fillings, Extractions | ||
| Periodontics (Gum Treatment) | ||
| Endodontics (Root Canals) | ||
| Major Services | ||
| Crowns, Dentures, Bridges | ||
| Orthodontia – Lifetime Maximum | ||
| Child/Adult Coverage | ||
* Deductible does not apply to the services where the “*” is notated.
Dental Preferred Provider Organization (DPPO):
- When visiting an out-of-network dentist, please remember that you are responsible for amounts in excess of charges above the allowable amounts. Out-of-network dentists are not contracted with the carriers; therefore, members may expect to pay more for utilizing a dentist outside of the network.
- A pre-determination of benefits is recommended for treatment plans that amount to $300 or greater so you can make an informed decision.
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