Dental
This summary is an overview of your benefits only. Refer to your plan booklet for a complete description of benefits provided. The plan booklet and your eligibility for benefits will determine how your benefits are paid.
Delta Dental PPO Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$50/$150
Out-of-Pocket Max (Per Individual)
$2,500
Preventive Care
$0
Basic Services
20% after Deductible
Major Procedures
50% after Deductible
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,500 per individual; deductible waived
Out-of-Network*
Deductible (Individual/Family)
$50/$150 (Combined with In-Network)
Out-of-Pocket Max (Per Individual)
$2,500 (Combined with In-Network)
Preventive Care
$0
Basic Services
20% after Deductible
Major Procedures
50% after Deductible
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,500 per individual; deductible waived
* Out-of-Network benefits are paid at the 90th percentile and may be subject to balance billing