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Delta Dental

Your Dental Plan

Delta Dental DHMO Pre-Paid Plan

This plan provides dental care services at a fixed cost when you go to a dentist who is a member of Delta Dental's DHMO network. Similar to a medical HMO, the plan requires you and each of your covered dependents to choose a primary care dentist from Delta Dental's network. You must receive all your non-emergency dental care from your Delta Dental DHMO network dentist.

Delta Dental DPPO Plan

This plan is a preferred provider program that gives you the option of receiving treatment from any licensed dental provider you choose. If you go to a dentist who is a member of Delta Dental's DPPO network, you will receive a higher level of benefits and reduce your out-of-pocket costs. If you decide to go to a dentist outside of the DPPO network, the plan's benefits will be based on the Usual and Customary (U&C) charge for a particular dental service in your area. If your out-of-network dentist charges more than the U&C amount allowed by the plan, you have to pay the difference.

Dental Benefit Summary
Dental Benefits Dental HMO
(DeltaCare USA)
Dental PPO
(In & out-of-network)
* deductible waived
Annual Deductible No deductible$50 per individual
$150 per family
Annual Maximum Unlimited$1,750 per person
Diagnostic & Preventive Services
100% covered100% covered*
Basic Services Copay varies80%
Endodontic & Periodontic ServicesCopay varies80%
Major ServicesCopay varies50%
Orthodontia$1,700 child copay
$1,900 adult copay
50% up to $1,500 lifetime maximum benefit*
(adults and dependent children)
Employee Cost per Paycheck
Coverage Level HMOPPO
Employee Only $0.00$21.28
Employee + Spouse $7.13$44.27
Employee + Child(ren) $7.07$54.27
Employee + Family $14.52$79.85

Find a Network Dentist

Visit www.deltadentalins.com to find an in-network dental provider. Use the Dental Delta PPO network for DPPO and DeltaCare USA network for DHMO.

Go to Delta Dental »
Balance Billing

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. This typically occurs when utilizing out-of-network or non-preferred providers.