Welcome to Delta Dental! 2021-22 Open Enrollment - A dental election is REQUIRED if you want dental insurance coverage for yourself and your ...
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Welcome to Delta Dental! 2021-22 Open Enrollment A dental election is REQUIRED if you want dental insurance coverage for yourself and your family in the new plan year!
Delta Dental PPO™
The Delta Dental Difference®
Delta Dental PPO Delta Dental Premier® Non–Delta Dental
• Visit a PPO dentist to
save the most.
• You can visit any
licensed dentist.
• You won’t be charged
more than your
expected share of
the bill.
Delta Dental PPO
In-Network – &
Premier
PPODelta
BASEDental PPO –
PLANNon-Delta
$75 perBASE PLAN
person,
Employee PPO
Pays
providers
Employee Pays
Diagnostic and
Deductible $100 per person, Premier
preventive
Comprehensivecare year
Per calendar 0%& Non-Contracted50%
(exams, cleanings,
orthodontics – CHILD 50%
providers
x-rays,
ONLY sealants) Waived for D&P
Basic services
Comprehensive
Annual
maximum
(Fillings, simple (Adult) Not covered
30%
orthodontics 20%$1,500 per person
extractions, root year
Per calendar (after
(after deductible) $1,500
Lifetime
canals, gumMaximum deductible)
Orthodontic
treatment)
$1,500 per person
MajorLifetime maximum
services 80%
(Crowns, oral 70%
(after
surgery, bridges, (after deductible)
dentures)
deductible)
Your PPO coverage
BUY-UP PLAN
In-Network Premier &
Delta DentalNon-Delta
PPO PPO –
BUY-UP PLAN
Delta Dental
Employee PaysPPO –
$50 per person
BUY-UP PLAN
Deductible
Diagnostic and
Per calendar
$150 per family
preventive careyear 0% Employee
Waived Pays
20%
for D&P
(exams, cleanings,
Comprehensive
Annual
x-rays, maximum
sealants) 50%person
$2,000 per
orthodontics
Per calendar(child)
Basic services year
Comprehensive
(Fillings, simple 20%
Orthodontic
extractions, root 50% 50%
orthodontics (adult)
Lifetime maximum $2,000 per
(after deductible) person
(after deductible)
canals, gum
Lifetime
treatment)Maximum $2,000
Major services
(Crowns, oral 50% 70%
surgery, bridges, (after deductible) (after deductible)
dentures)Pre-treatment estimate
DeltaCare® USA DHMO
The DHMO is available in the following states:
• Alabama • New Jersey *The Delta DHMO is only
available in approved
• Arizona • New York
states – the following are
• Arkansas • North Carolina pending approval:
• Delaware • Pennsylvania • California (pending)
• Florida • South Carolina • Colorado (pending
• Maryland (pending)
• Illinois • Tennessee
• Ohio (pending)
• Indiana • Texas • Oregon (pending)
• Kansas • Virginia • Washington (pending)
• Michigan • Washington DC
• Mississippi • Wisconsin
• Missouri
*Pending as of 12/14/2020Comprehensive coverage
DeltaCare USA DHMO: a prepaid, fixed copayment plan
DHMOenrolled,
Once benefit enhancements
select a primary
dentist from the DeltaCare USA
include:
network
• 178tomore
startcovered
enjoying:
DHMO
• procedures;
Set copays all-inclusive
• copays
No annual maximums
•• Posterior composite fillings
No deductibles
covered
• No claims
• No missing tooth exclusion
• Low premiums
• Implants covered
• Tooth whitening coveredHow DeltaCare USA DHMO works Getting dental care is easy
Specialty and emergency care
DeltaCare USA DHMO
• If you need specialty care, your
primary care dentist will refer you
• Your primary care dentist requests
authorization for specialty services
• Plan includes out-of-network coverage
for emergenciesAll about braces DeltaCare USA DHMO • Orthodontic coverage for children and adults • All phases of orthodontic treatment are covered • Pre-and post-records • Tooth extractions • Coverage for in-progress treatment • Sampling of pre-set copays (please refer to full summary for additional details):
Teeth Whitening & Implants
New with the DeltaCare USA DHMO
DeltaCare USA
Your copayment*
Teeth Whitening
External bleaching for home application,
per arch; includes materials and $125 copayment
fabrication of custom trays
Implants
Surgical placement of implant body:
$1,005 copayment
endosteal implant
Custom fabricated abutment – includes
$425 copayment
placement
Abutment supported porcelain/ceramic
$740 copayment
crown
*Limitations and exclusions may apply. Sample listing of procedure codes. Please reference plan booklet for complete listing of covered
procedure codes.Go to deltadentalins.com to browse the DeltaCare USA
dentists in your area.
Write down the facility number of the primary care
dentist you would like.
Submit your request
• Online: Create an online account at
deltadentalins.com
• By phone: Call Customer Service at 800-422-4234
Each member school will document dentist election
and communicate to Delta Dental. If no election is
made, a provider will be auto assigned. Providers can
be changed anytime throughout the year.Web and mobile resources
Sign up for an online account
Check your benefits information online –
deltadentalins.com
• Check your plan details: eligibility, covered
services and level of benefits.
• Look up claim statements for recent dental visits.
• View or print your ID card.
• Estimate the cost of your next procedure.
• Submit questions to Customer Service.Go mobile
What can you do with the app?
To find the app, visit the App Store or Google Play and
search for “Delta Dental.” Then download the Delta
Dental app by Delta Dental Plans Association.Find a network dentist
• Go to deltadentalins.com.
• Look for the Find a Dentist tab.
• Search by name, address, landmark, city or ZIP code.
• Select your network plan.
• Click Search.
• Narrow your search by location, specialty, network and
language.
• Your search results will include a dentist’s Yelp rating,
address and phone number.Cost Estimator Budget for dental expenses with personalized estimates Personalized. Estimates are based on your benefits, including maximums and deductibles. Insightful. Compare the cost of the same procedure at different dentists. Economical. See how choosing an in-network dentist can help you save.
Value Added Service: Savings you can hear!
Access hearing aid and LASIK discounts
Now available to you and your dependents
Amplifon Hearing 62% average savings off retail
Health Care hearing aid pricing
40-50% off traditional LASIK
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