Plan Overview*
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Delta Dental PPO™ |
Delta Dental Premier® |
Non-Network Dentist** |
Annual Deductible (waived for annual and semi-annual exams with prophylaxis and bitewings) |
$25 per family |
Annual Family Maximum |
$2,500*** |
Annual and semi-annual exams with prophylaxis and bitewings |
100% |
100% |
100% |
All other COVERED Dental Services |
80% |
80% |
80% |
*This is a summary only. If discrepancies arise, the Summary Plan Description (SPD) will govern.
Please refer to your SPD for a more complete listing of services including plan limitations and exclusions.
**Using a non-network dentist may cost you more out-of-pocket.
***Maximum benefit does not apply to pediatric dental care up to the age of 19. However expenses incurred will accumulate towards the Maximum Benefit per calendar year per family.
View Sample Claims.