The Dental PPO is provided by Delta Dental. This option offers the convenience and flexibility of visiting a Delta Dental PPO or Premier Dentist within the United States. You will receive the highest benefit coverage when you visit Delta Dental PPO dentist. For out-of-network coverage, see the Pay, Stock and Benefit Handbook.
Benefits are payable after you satisfy an annual $50 deductible per person.
Preventive and Diagnostic services
Preventive and Diagnostic services include two annual exams, routine x-rays and cleanings. The deductible is waived for all preventive and diagnostic services. These services are covered at 100% when performed by a Delta Dental PPO dentist or 90% when received from a Delta Dental Premier dentist.
Major services
Major services include complex dental work, like crowns and bridges. These services are covered at 60% and you pay the remaining 40% after the deductible – up to an annual maximum.
Orthodontic services
The Delta Dental PPO plan provides orthodontic coverage for adults and children. Orthodontic services are covered at 50% up to a lifetime benefit maximum. The network your dentist participates in will determine your annual benefit maximum.
Annual Benefit Maximum
The annual benefit maximum is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care for a calendar year. The network your dentist participates in will determine your annual benefit maximum.
PPO Dentist
$2,500
Premier Dentist
$2,000
Out-of-network Dentist
Major Services
Your coinsurance: 40%
Preventative and diagnostic Services
Excluded from maximum
Orthodontia Lifetime Maximum
Once the orthodontia lifetime maximum has been reached, it is no longer considered a covered dental service. The lifetime orthodontia maximum is separate from the dental annual benefit maximum. The network your dentist participates is in what determines your orthodontia maximum amount.
PPO Dentist
$2,500
Premier Dentist
$2,000