What is a deductible?
A deductible is the amount you pay out-of-pocket each year before your plan begins to pay for covered dental treatment costs. Generally, Delta Dental PPOTM and Delta Dental Premier® plans have deductibles, but DeltaCare® USA, our prepaid, fixed copayment plan, does not.1
How can I check my plan deductible?
There are three ways to check the amount of your remaining deductible:
- Log in to your online account. (To set up your online account, follow the easy, three-step registration process.) Once you’ve logged in, click on the Benefits tab and scroll down to the Deductibles section.
- Call our interactive voice response telephone line.
- Ask your dental office for your plan’s deductible information.
What you should know if you have a deductible
- If your dental plan is based on a calendar year (January through December), you’ll pay your deductible once each calendar year. If your plan is based on a contract year (starts and ends during a different 12-month period), you’ll pay your deductible once each plan year.
- It might take more than one service or visit to satisfy your entire annual deductible.
- Depending on your dental plan, some services might not count toward your annual deductible, such as diagnostic and preventive services. In that case, you would be responsible for any applicable coinsurance (though many plans cover diagnostic and preventive services at 100%) or additional charges when visiting a non-network dentist.2 Refer to your plan booklet or Policy for more information about covered services, deductibles and maximums.
- When your dentist submits a claim for a service, your deductible is applied first, and then any coinsurance is calculated.
For example: You have a two-surface filling on a molar that costs $200 and this service is covered at 80% under your plan. There is a $50 deductible.
You pay the deductible of $50, leaving a $150 balance for the service. The balance of $150 is covered at 80%, so your plan pays $120. That leaves $30 for you to pay, in addition to the $50 deductible. So, your total out-of-pocket cost for the service is $80.
Here’s the calculation for this service:
Cost of Service $200 Deductible (you pay) $50 Amount Plan Pays — 80% of $150 (balance after deductible is paid) $120 Remaining Balance (after you pay the deductible and the plan payment is calculated) $30 Total Amount You Owe = Deductible + Remaining Balance $80
- When you have a family deductible, the individual deductible applies per person until the family deductible amount is reached. At that point, the family deductible is considered to be met.
For example: If your plan has an individual deductible of $50 and a family deductible of $150, the first three family members would each satisfy the individual deductible of $50. If there are additional family members seeking treatment, there would be no further deductible requirements for that year.
Your Explanation of Benefits, Explained!
1Refer to your plan booklet or Policy for more information about covered services, deductibles and maximums.
2Delta Dental dentists agree to our determination of fees and won’t bill you more than your share of Delta Dental’s approved fee for a covered service. Non-Delta Dental dentists have no fee restrictions. When you visit a non-Delta Dental dentist, you’re responsible for any amount the dentist charges above our allowance for that service.