Delta Dental, our dental plan provider, offers a large network, but you have the freedom to visit any dentist you like. If you use a network dentist, you'll usually pay less and you won't have to file paperwork or claims.
Plan 1 Ortho | Plan 2 No Ortho | |||
---|---|---|---|---|
General Provisions | In-Network | Out-of-Network | In-Network | Out-of-Network |
Provider Choice | You can use any licensed dentist you choose; however, your out-of-pocket costs are likely to be less than when you use in-network providers, since benefits are based on negotiated fees. When you use out-of-network providers, you pay your percentage of the reasonable and customary (R&C) amount, plus any amounts the provider charges above R&C. | |||
Annual Deductible | $50 per covered person | $50 per covered person | ||
Annual Maximum Benefit | $2,000 per person per year | $1,000 per person per year | ||
Plan Benefits | ||||
Preventive Services* | 100%, no deductible | 100% of R&C, no deductible | 100%, no deductible | 100% of R&C, no deductible |
Basic Care | 80% after deductible | 80% of R&C after deductible | 80% after deductible | 80% of R&C after deductible |
Oral Surgery | 80% after deductible | 80% of R&C after deductible | 80% after deductible | 80% of R&C after deductible |
Major Restoration | 50% after deductible | 50% of R&C after deductible | 50% after deductible | 50% of R&C after deductible |
Orthodontia | 100% after annual deductible; $2,000 lifetime maximum per person | Not covered |
*Includes 2 cleanings per year
General Provisions | In-Network | Out-of-Network |
---|---|---|
Provider Choice | You can use any licensed dentist you chose; however, your out-of-pocket costs are likely to be less when you use in-network providers, since benefits are based on negotiated fees. When you use out-of-network providers, you pay your percentage of the reasonable and customary (R&C) amount, plus any amounts the provider charges above R&C. | |
Annual Deductible | $25 individual; $75 per family* | |
Annual Maximum Benefit | $2,000 per person per year* | |
Preventive Services** | 100%, no deductible | 100% of R&C, no deductible |
Basic Care | 80% after deductible | 80% of R&C after deductible |
Oral Surgery | 80% after deductible | 80% of R&C after deductible |
Major Restoration | 50% after deductible | 50% of R&C after deductible |
Orthodontia | 100% after annual deductible;$2,000 lifetime maximum per participant |
*In- and out-of-network combined
**Includes two cleanings per year
To find a participating dentist or see if your dentist participates in the Delta Dental network, visit deltadentalins.com. Use the site for secure access to your personal plan information and to see the cost of dental procedures.
Reminder: No Delta Dental ID cards are provided or needed.