Plan Overview*

Benefit Deductibles, Coinsurance and Maximums

To search for a network dentist click here	Delta Dental PPO™	Delta Dental Premier	Non-Network Dentist**
A -- Preventive & Diagnostic Services not subject to a deductible	100%	100%	100%
Annual Deductible applies to Basic and Major Services	$50 per person / $150 per family
B -- Basic Dental Care	80%	80%	80%
C -- Major Dental Care	50%	50%	50%
*Annual Benefit* Maximum (A,B & C Services)**	$1,500	$1,500	$1,500
D -- Orthodontic Services	50%	50%	50%
*Lifetime Benefit* Maximum (Orthodontic Services Only)**	$1,500	$1,500	$1,500

*Please refer to your Delta Dental Summary Plan Description (SPD) for detail of the services provided in each benefit level.

**Using a non-network dentist may cost you more out-of-pocket.

View Sample Claims.