Obtain benefit and eligibility information, claims status, and more.
Shortcuts
Corporate Information
| Coverage under Delta Dental Premier Basic | Delta Dental PPO | |||
|---|---|---|---|---|
| Employees and Dependents | In-Network Delta Dental PPO dentists (1) | Out-of-Network (non- Delta Dental PPO dentists) | ||
| Who's covered? (primary enrollee, spouse and eligible children) | Employees | Dependents | Employees, Retirees and Dependents | Employees, Retirees and Dependents |
| Deductible (per person annually) | $50 | $50 | $25 | $75 |
| Family Deductible (annually) | $150 | $150 | $100 | $200 |
| Maximum (per person annually) | $2,000 | $1,000 | $2,000 | $1,000 |
| Diagnostic and Preventive (no deductive) | 100% of Delta Dental dentist's fees | 100% of Delta Dental dentist's fees | 100% of Delta Dental dentist's fees | 80% of Delta Dental approved fee (2) |
| Basic Benefits: (extractions, root canals, periodontic treatment, sealants) | 90% of Delta Dental dentist's fee | 90% of Delta Dental dentist's fee | 90% of Delta Dental PPO approved fee | 80% of Delta Dental approved fee |
| Crowns and cast restorations | 80% of Delta Dental dentist's fee | 50% of Delta Dental dentist's fee | 80% of Delta Dental PPO approved fee | 50% Delta Dental approved fee |
| Prosthodontic bridges, dentures | 50% of Delta Dental dentist's fee | 50% of Delta Dental dentist's fee | 60% of Delta Dental PPO approved fee | 50% Delta Dental approved fee |
| Orthodontic | 50% of Delta Dental dentist's fee | 50% of Delta Dental dentist's fee | 50% of Delta Dental PPO approved fee | 50% Delta Dental approved fee |
| Orthodontic Maximum | $1,000 lifetime maximum | $1,000 lifetime maximum |
$1,000 lifetime maximum per adult $1,500 per child |
$1,000 lifetime maximum per adult $1,500 per child |
| Implant Benefits | Not covered | Not covered | 50% of Delta Dental PPO approved fee $2,500 lifetime maximum | 50% of Delta Dental approved fee $2,500 lifetime maximum |
| Other Coverage | Third cleaning per year for high-risk patients (3) | Third cleaning per year for high-risk patients (3) | ||
| Delta Dental Premier (Basic) | Delta Dental PPO | ||
|---|---|---|---|
| EE only | $11.36 | EE only | $9.19 |
| EE and 1 dependent | $20.00 | EE and 1 dependent | $19.54 |
| EE and 2+ dependents | $29.00 | EE and 2+ dependents | $29.49 |
(1)* In California, Delta Dental endodontists, oral surgeons and periodontists are not Delta Dental PPO dentists, but you receive in-network benefits when visiting one of these specialists. You must visit a Delta Dental PPO prosthodontist or Delta Dental PPO orthodontist in order to receive the maximum in-network benefits under the program.
(2) When visiting a non-Delta Dental PPO dentist, you pay the difference between the dentist's fee and the Delta Dental -approved fee plus the copayment.
(3) High-risk patients are defined as patients with compromising systemic diseases or medical conditions such as, but not limited to:
The need for the third cleaning will depend on the severity of the disease that the patient has. The Delta Dental dentist who is performing the treatment will determine the necessity of the third cleaning and submit proof to Delta Dental.
(4) For employees in Consolidated Benefits (CoBen), the monthly out-of-pocket premium may vary depending on their other CoBen elections.
Obtain benefit and eligibility information, claims status, and more.
© Delta Dental. This site is the home of Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, Delta Dental of the District of Columbia, Delta Dental of Delaware, Delta Dental of West Virginia, their affiliated companies, and Delta Dental of New York. For other Delta Dental Plans Association member companies, visit the Delta Dental Plans Association Web site.