Coverage offered through Delta Dental PPO PlusPremier Network
With your PPO plan you have the freedom to visit any dentist you choose. If you opt to use an In-Network Delta provider, however, the fees for services will be discounted and therefore you will pay less than if using an Out-of-Network Provider.
Click here to download the Delta Dental claim form.
Dental Educational Resources
- Healthy smiles for a lifetime: Basics of preventive dental care
- Visit the Delta Dental website: deltadentalins.com
- Delta Dental PPO— Easy, Friendly, Accessible
- Healthy smiles for a lifetime: Basics of preventive dental care (Spanish)
- Visit the Delta Dental website: deltadentalins.com (Spanish)
- Delta Dental PPO— Easy, Friendly, Accessible (Spanish)
Employee Only: $10
Employee + One: $25
The cost of enrolling in the plan is deducted from your pay on a pre-tax basis.
Dental Plan Summary
This chart summarizes the benefits provided under the Delta Dental PPO Plan. For more detailed information, please refer to your summary Plan description.
|Delta Dental PPO Plus Premier|
|Calendar Year Deductible*
(Waived for Diagnostic, Preventive and Orthodontic Care)
|Employee + One||$100||$100|
|Calendar Year Maximum*||$2,000/person||$2,000/person|
|Preventative Care (Twice Per Calendar Year)
Includes exams, cleanings, x-rays, fluoride treatments for children, emergency treatment, space maintainers, sealants
Includes laboratory tests, fillings (amalgam, silicate, acrylic), root canal, repair and relining of dentures, repair and recementation of bridgework and crowns, oral surgery, posterior composites, surgical and non- surgical periodontics
Includes porcelain fillings and crowns, installation of bridgework, dentures and crowns, implants, prosthodontic services
|Orthodontia Lifetime Maximum*||$2,000/child||$2,000/child|
*In- and Out-of-Network combined
**Orthodontic services limited to participants through age 18.