Coverage worth smiling about!

Dental Coverage

Delta Dental PPO

The plan covers a wide range of services, including routine checkups, fillings, crowns, and more. Preventive care is fully covered when you see an in-network dentist, and other services are covered based on the type of care and provider you choose.

In-Network
PPO Dentists

In-Network
Premier Dentists

Out-of-Network
Dentists

Annual deductible

Individual: $50;
Family: $150 per family

Annual maximum

$2,000 per individual

Diagnostic & preventive

No charge

No charge

No charge*

Basic services

10% after deductible

20% after deductible

20% after deductible*

Major services

40% after deductible

50% after deductible

50% after deductible*

Orthodontia (adults and children)

50% ($1,500 lifetime max)

50% ($1,500 lifetime max)

50% ($1,500 lifetime max)*

Your Bi-Weekly Cost of Coverage (26 periods)

Employee only

$0.00

Employee + spouse

$12.46

Employee + children

$15.69

Employee + family

$25.85

Pre-tax

Post-tax

Imputed

Employee + Domestic Partner (DP)

$0.00

$12.46

$6.14

Employee + DP + child(ren)

$15.69

$10.16

$14.71

Employee + DP
+ DP child(ren)

$0.00

$25.85

$30.89

Employee + DP
+ child(ren) + DP child(ren)

$15.69

$10.16

$14.71

*Reimbursement is up to the maximum contracted allowance.

Contacts

Delta Dental

Group #: 23271
Phone: 888-335-8227
Web: deltadentalins.com
Find a Provider
To find an in-network dentist in your area, visit deltadentalins.com, enter your location and network provider, then click "Find a dentist" to review your care options.

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