Delta Dental PPO plans give you flexibility to see any licensed dentist, however you’ll pay less when you choose a Preferred Dentist.
If you see a non-preferred provider, you’ll pay a share of the cost based on Reasonable and Customary (R&C) rates. Review your plan summaries for out-of-network coverage details.
| Plan Features | Delta Dental Low PPO | Delta Dental High PPO | ||
|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Calendar Year Benefit Maximum | $1,000 per person | $2,000 per person | ||
| Orthodontia Lifetime Maximum (adults + dependent children) |
$1,500 per person | $2,500 per person | ||
| You pay: | ||||
| Annual Deductible Individual/Family |
$50 / $150 | $50 / $150 | ||
| Preventive Services* | Covered in full** | Covered in full** | ||
| Basic & Restorative Services (e.g., fillings, extractions, root canals) |
30% after deductible | 20% after deductible | ||
| Major Services (e.g., dentures, crowns, bridges) |
50% after deductible | 50% after deductible | ||
| Orthodontic Benefits | 50%** | 50%** | ||
*Preventive care services apply toward the calendar year maximum.
**Deductible waived.
Delta Dental does not issue ID cards; however, you can print an ID card by setting up an account at deltadentalins.com. Your dental provider can also call (888) 335-8227 to verify your coverage.
