With two plan options available, you can choose the coverage that best meets your individual needs. Carefully review the benefit summary chart to determine which plan is right for you.
|Plan A||Plan B|
|*Delta Dental’s payment under this plan is limited to the applicable percentage of the lesser of: a) your dentist’s actual charges; or b) the Delta Dental PPOSM Maximum Plan Allowance (the highest amount that Delta Dental will pay to a Delta Dental PPO dentist where you received the services). You will be required to pay the balance of the dentist’s fee not paid by Delta Dental. When receiving treatment from a Delta Dental Premier® (Premier) dentist, you may be required to pay any cost above the Delta Dental PPO Maximum Plan Allowance, up to your dentist’s Premier Maximum Plan Allowance. When receiving treatment from a Non-Delta Dental dentist, there is no limit regarding their fees.
Note: The PPO network is not available in Alaska, South Dakota or Wyoming. In North Carolina and Texas, the PPO network is referred to as DPO.
In Massachusetts, there are no Delta Dental PPO licensed dentists located in Dukes or Nantucket counties. Enrollees whose primary residences are located in Dukes or Nantucket counties may receive covered services from any licensed dentist located in those counties. Enrollees’ out-of-pocket costs for covered services will be calculated based upon the PPO Maximum Plan Allowance as though such care is provided by a Delta Dental PPO licensed dentist, so that they will receive the cost-limiting advantages available from Delta Dental PPO licensed dentists.
In all counties in Massachusetts, covered services may be obtained from any specialist, whether a Delta Dental PPO licensed dentist or other licensed dentist. Enrollees’ out-of-pocket costs for services from all specialists will be calculated based on the PPO Maximum Plan Allowance as though such care is provided by a Delta Dental PPO specialist, so that they will receive the cost-limiting advantages available from Delta Dental PPO licensed dentists.
|Delta Pays*||Member Pays||Delta Pays*||Member Pays|
|Benefits in Year 1|
|Diagnostic and preventive (includes exams, x-rays and cleanings). NOTE: In Plan A, no deductible required for diagnostic or preventive services. In Plan B, Calendar Year Deductible applies.||100%||0%||80%||20%|
|Periodontal maintenance cleanings (gum cleanings)||80%||20%||50%||50%|
|Restorations (including tooth-colored fillings)||50%||50%||50%|
|Endodontics (root canals)||50%||50%||50%||50%|
|Additional Benefits After One Year of Continuous Enrollment|
|Periodontics (gum disease treatment)||50%||50%||50%||50%|
|Crown and cast restorations||50%||50%||50%||50%|
|Dental implant services||50%||50%||50%||50%|
|Temporomandibular Joint Dysfunction (TMJ)||50%||50%||50%||50%|
|Additional Benefits With Annual Rate Payment|
|Dental Accident ($1,000 lifetime maximum)||100%||0%||Not a benefit in Plan B|
|Deductibles and Maximums per Enrollee|
|Calendar Year Deductible||$50||$100|
|Calendar Year Maximum Benefit||$1,500||$1,000|
|Temporomandibular Joint Dysfunction — Lifetime Maximum||$300||$300|
|Bold items indicate the differences between Plan A and B.|
This is only a summary of the benefits available with the AARP Dental Insurance Plan. Please view the Certificate of Coverage/Benefit Handbook for a complete description. Also, you can view the plan's Limitations and Exclusions.