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Network Options: PPO or Premier Networks
Delta Dental makes using your benefits a snap. Create an account and they will give you simplified access and tools to manage your dental plan. They offer easy online tours on how to find choose a dentist, log in to the web portal, download our app or request a pre-determination of benefits.
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Dental Plans |
DELTA DENTAL LOW PLAN - PPO OR PREMIER NETWORK
In-Network
Out-of-Network*
Annual Deductible
June 1 - May 31
June 1 - May 31
You pay up to
$50 per individual
$150 per family
$50 per individual
$150 per family
You pay up to
$50 per individual
$150 per family
$50 per individual
$150 per family
Annual Maximum
June 1 - May 31
June 1 - May 31
Plan pays up to
$1,000 per individual
$1,000 per individual
Plan pays up to
$1,000 per individual
$1,000 per individual
Preventive Services
See Plan Summary for more details
See Plan Summary for more details
Plan pays
90% for covered services
No Deductible Applies
90% for covered services
No Deductible Applies
Plan pays
90% of Fee
No Deductible Applies
90% of Fee
No Deductible Applies
Basic Services
See Plan Summary for more details
See Plan Summary for more details
Plan pays up to
60% AD
60% AD
Plan pays up to
60% of Fee AD
60% of Fee AD
Major Services
See Plan Summary for more details
See Plan Summary for more details
Plan pays up to
50% AD
50% AD
Plan pays up to
50% of Fee AD
50% of Fee AD
Orthodontic Services
Children to age 26
Children to age 26
Plan pays up to
50%
50%
Plan pays up to
50% of Fee
50% of Fee
Orthodontic Lifetime Maximum
$1,000 per child to age 26
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2024-2025 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2024-2025 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
DELTA DENTAL HIGH PLAN - PPO OR PREMIER NETWORK
PPO Network
Premier Network
Out-of-Network*
Annual Deductible
June 1 - May 31
June 1 - May 31
You pay up to
$50 per individual
$150 per family
$50 per individual
$150 per family
You pay up to
$50 per individual
$150 per family
$50 per individual
$150 per family
You pay up to
$50 per individual
$150 per family
$50 per individual
$150 per family
Annual Maximum
June 1 - May 31
June 1 - May 31
Plan pays up to
$1,500 per individual
$1,500 per individual
Plan pays up to
$1,500 per individual
$1,500 per individual
Plan pays up to
$1,500 per individual
$1,500 per individual
Preventive Services
See Plan Summary for more details
See Plan Summary for more details
Plan pays
100% for covered services
No Deductible Applies
100% for covered services
No Deductible Applies
Plan pays
80% for covered services
No Deductible Applies
80% for covered services
No Deductible Applies
Plan pays
80% of R&C for covered services
No Deductible Applies
80% of R&C for covered services
No Deductible Applies
Basic Services
See Plan Summary for more details
See Plan Summary for more details
Plan pays up to
80% AD
80% AD
Plan pays up to
60% AD
60% AD
Plan pays up to
60% of R&C, AD
60% of R&C, AD
Major Services
See Plan Summary for more details
See Plan Summary for more details
Plan pays up to
50% AD
50% AD
Plan pays up to
40% AD
40% AD
Plan pays up to
40% of R&C AD
40% of R&C AD
Orthodontic Services
Children to age 26
Children to age 26
Plan pays up to
50%
50%
Plan pays up to
50%
50%
Plan pays up to
50% of R&C
50% of R&C
Orthodontic Lifetime Maximum
$1,200 per individual
$1,200 per individual
$1,200 per individual
AD: After Deductible
R&C: Reasonable & Customary
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2024-2025 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
R&C: Reasonable & Customary
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2024-2025 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
