Notice

Happy Thanksgiving! Our offices will be operating during normal call center hours from 8:00 AM to 5:00 PM ET on Wednesday, November 27th. We will be closed on Thursday, November 28th and Friday, November 29th to allow our associates time to spend with their families and loved ones. We wish you a wonderful holiday filled with gratitude and joy!

 

We apologize for any inconvenience this may cause. Please self-service by signing into your account or using our Interactive Voice Response System (IVR) 24/7 at 800-452-9310.

Delta Dental PPO plus Premier™ - Basic

Group #4616

Effective 1/1/25, for Delta Dental Basic and Delta Dental Plus plans, preventative services will no longer apply towards annual benefit maximum.

Service Delta Dental PPO Plus Premier™
Basic plan
Calendar year maximum (per person) $1,000
Calendar year deductible (waived on Preventive & Diagnostic)
    Per person $50
    Family aggregate $100
Preventive & Diagnostic   
    Exams, Cleanings, Bitewing X-Rays (2 per calendar year) 100%
    Fluoride treatment (2 per calendar year for children to age 19) 100%
    Sealants (to age 16) 100%
Basic Services (after deductible)  
    Extractions, Root canals (Endodontics)          80%
    Periodontal, Oral surgery 80%
    Repair of dentures            80%
    Fillings - Composite/Resin (anterior & posterior teeth) 80%
Crowns & Prosthodontics (after deductible)   
    Crowns, gold restorations (payable every 8 years) Not a benefit
    Bridgework, full and partial dentures (payable every 8 years) Not a benefit
    Implants Not a benefit
Orthodontics (Adult and Dependent Children)  
    Co-insurance              Not a benefit
    Lifetime maximum (per person) N/A
TMJ  
    Co-insurance              Not a benefit
    Lifetime maximum (per person) N/A

Delta Dental’s Oral Health Enhancement Option enables you to receive up to four dental cleanings and/or periodontal maintenance procedures in any combination per benefit period if you have been treated for periodontal (gum) disease in the past. For the additional dental cleanings and/or periodontal maintenance procedures to be covered, you must have had periodontal surgery or periodontal scaling and planing in the past. Details on how to qualify can be found in your benefit booklet.

Your dentist's network will impact how much you pay. Dentists that help participate in the Delta Dental PPO will have the lowest costs and will save you the most out of pocket expense. Dentists that participate in Delta Dental Premier, are participating Delta Dental dentists, but you will pay a greater portion of the cost if utilized. If you receive services from a non-participating, out of network dentists, you will pay the most out of pocket and are responsible for your coinsurance amount plus the difference between Delta Dental's approved fee and the dentist submitted fee for the claim.