Delta Dental - PPO Plan
| Dental Highlight Chart | |||
|---|---|---|---|
| Delta Dental PPO (In Network) |
Delta Premier | Non-Network | |
|
Explanation of Network |
Employees receive highest level of benefits when selecting dental providers from this network.
|
- Payment benefit level slightly lower than Delta Preferred. - Employees are not responsible for charges exceeding “usual and customary.” |
Employees who use out-of-network dental providers are responsible for any charges exceeding “usual and customary.” |
|
Preventative & Diagnostic |
100% deductible does not apply |
90% deductible does not apply |
90% deductible does not apply |
|
Annual Deductible |
$50 |
$75 |
$75 |
|
Basic Services |
80% |
50% |
50% |
|
Major Services |
60% |
50% |
50% |
|
Annual Maximum Benefit Per Person |
$1,800 |
$1,500 |
$1,500 |
|
Orthodontic Lifetime Benefit for Children up to 19 Yrs |
50% coverage up to maximum of $1,000 |
50% coverage up to maximum of $1,000 |
50% coverage up to maximum of $1,000 |
Note: Implants and related services not covered