|
Type of Plan | Plan pays your chosen dentist a monthly fixed rate to provide services as needed. | Fee-for-service plan. Plan provides reimbursement for services rendered. |
Plan provides maximum benefit when you visit an in-PPO network dentist. |
|
Dental
Providers | Must select a dental provider affiliated with the prepaid plan. | Any licensed dentist. However, out-of-pocket expenses may be lower when visiting a Delta Dental PPO dentist. |
Any licensed dentist, but maximum benefit when visiting a PPO network dentist. If an out-of-PPO network dentist is used, benefits are lower. |
|
Orthodontic
Providers | Must use orthodontist affiliated with the prepaid plan. | May visit any orthodontist. However, out-of-pocket expenses may be lower when visiting a Delta Dental PPO dentist. |
Must visit an in-PPO network orthodontist to receive maximum benefit. |
|
Changing
Providers | You may change to another dentist affiliated with the plan, with prior approval. | May change dentist at any time. |
May change dentist at any time. |
|
Deductibles | No deductible. | Basic: $50 per person, up to $150 annual maximum per family. Enhanced: $25 per person, up to $100 annual maximum per family. | $25 per person, up to $100 annual maximum per family, for PPO network dentists. $75 per person up to $200 annual maximum per family for PPO network dentists. |
|
Co-payments | Co-payments for certain covered procedures. May require payment at time of treatment. | You pay only the co-payment and any deductibles and charges above the annual maximum for covered services when visiting a
Delta Dental dentist.
When visiting a non-Delta Dental dentist, you also pay the difference between the dentist’s submitted charges and Delta Dental’s
approved fees. | You pay only the co-payment and any deductibles and charges above the annual maximum for covered services when visiting a
Delta Dental dentist.
When visiting a non-Delta Dental dentist, you also pay the difference between the dentist’s submitted charges and Delta Dental’s
approved fees. |
|
Plan Payments | Plan pays dentist monthly contract fee. | Payments based on Delta Dentist contracted fees or the maximum plan allowance when non-Delta Dental dentists are used. | Payments based on Delta Dentist contracted fees or the maximum plan allowance when non-Delta Dental dentists are used. |
|
Maximum
Benefits per
Calendar Year | No Maximum. | Basic: $2,000 for retiree, $1,000 per dependent. Enhanced: $2,000 for retiree and each eligible dependent. | $2,000 for retiree $2,000 per eligible dependent when PPO network dentists are used., $2,000 per eligible dependent when PPO network dentists are used. $1,000 for retiree, $1,000 per eligible dependent when non-PPO network dentists are used. |
|
Implant
Benefit | Premier Access and Western Dental only. | Not a covered benefit. | Maximum lifetime benefit of $2,500 for each retiree and dependent, if using a PPO plan provider. |
