What is a maximum?

There are two types of maximums — annual and lifetime.

An annual maximum is the most money a dental plan pays for dental care for you or your family (under a family plan) within a 12-month benefit period. Once you reach the maximum amount, you’ll be responsible for paying any costs for the remainder of the benefit period.

A lifetime maximum is the most money a dental plan pays for dental care for an enrollee or a family (under a family plan) for the life of the enrollee or family or the life of the plan.* Lifetime maximums usually apply to specific services, such as orthodontic treatment (braces).

Generally, Delta Dental PPO and Delta Dental Premier® plans have maximums, but DeltaCare® USA, our prepaid, fixed copayment plan, does not.

Please refer to your plan booklet or Policy for more information about covered services, deductibles and maximums.

How can I check my plan maximum(s)?

There are three ways to check how much remains before reaching any plan maximum(s).

What you should know if you have a maximum

  • Your dental plan could be based on a calendar year (January through December) or a contract year (starts and ends during a different 12-month period). Once you reach the annual maximum, you’re responsible for all costs for the remainder of the plan year.
  • Depending on your dental plan, some services might not count toward your maximum, such as diagnostic and preventive services.
  • Most fee-for-service dental plans, such as PPO and Premier, have an annual maximum.
    • Your plan may have different maximums depending on what dentist you visit. (For example, you may have a higher maximum if you visit a PPO dentist or any Delta Dental contracted dentist).

* Typically, if you move to another Delta Dental plan, your lifetime maximum would still be in force. (In other words, if you already met the maximum, you would have no more benefit.) If you’re moving from another dental carrier to a Delta Dental plan, carrying over the lifetime maximum will depend on whether your previous carrier has provided that information to us. You can contact Customer Service to find out once your Delta Dental plan is in effect.

After a visit to the dentist, you may receive an Explanation of Benefits, or EOB. Find out what an EOB is and how to read it.

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