Under this Delta Dental plan, you may see any dentist.
However, your out-of-pocket costs are lower when you use a dentist on Delta's Preferred Provider Option (PPO)Preferred Provider Organization (PPO)A health care plan that has a contractual agreement with providers to offer health care services at discounted, negotiated fees within a network. The PPO plans may require some cost-sharing with deductibles, copays and/or coinsurance. list.
Once you meet the deductible, you'll be responsible for a percentage of your covered costs, known as coinsuranceCoinsuranceThe portion of expenses that you have to pay for certain covered services, calculated as a percentage. For example, if the coinsurance rate is 20%, then you are responsible for paying 20% of the bill, and the insurance company will pay 80%. . Adults age 19 or older are eligible for the orthodontic benefitOrthodontic CoverageA treatment that aligns a person’s teeth, which may include the use of braces. with this plan.
Plan details
| Features & Considerations | |||
| Plan type | PPO Provider Network | Premier Provider Network** | Non-Participating*** |
| Plan-year benefit | $2,500* | $2,500* | $2,500* |
| Deductible (Children under 13 excluded) | $25 per person | $75 per person | $75 per person |
| Preventative & Diagnostic Services | 0% coinsurance and no deductible | 0% coinsurance and no deductible | The non-participating percentage of benefits is limited to the non-participating Maximum Plan Allowance. You will be responsible for the different between the non-participating Maximum Plan Allowance and the full fee charged by the dentists. |
| Basic Services | 20-25% coinsurance | 40-50% coinsurance | 40-50% coinsurance*** |
| Major Services | 25% coinsurance | 60% coinsurance | 60% coinsurance*** |
| Orthodontics | 40% coinsurance after deductible | 60% coinsurnace after deductible | 60% coinsurnace after deductible*** |
*Combination of in and out-of-network services.
**The Premier percentage of benefits is limited to the Premier Maximum Plan Allowance.
***The non-participating percentage of benefits is limited to the non-participating Maximum Plan Allowance. You will be responsible for the difference between the non-participating Maximum Plan Allowance and the full fee charged by the dentist.