2000 PPO
Plan Effective Date: 01/01/2022Providers
Under the Delta Dental PPO plans, members may choose to receive dental services from any licensed dentist without a referral. If a member chooses to receive services from a Delta dentist from the PPO provider network, the calendar year Per Person Per Year (PPPY) maximum benefit will be higher and the member's out-of-pocket expenses will be less.
Plans can only be changed during the annual Open Enrollment or within 30 days of a qualifying life event.
How to Find an In-Network Dentist
Go to www.deltadentalins.com
Click on "Find a dentist"
Enter a zip code to search for a dentist
Select a network: Delta Dental PPO
Click "Find a dentist"
Choose a dentist/dental group to receive services from
Out-of-Pocket Costs
The amounts that a member pays when utilizing services.
Deductible
Annually$25 / $75
Individual / Family
Cleanings
3 Times/Calendar Year100% coverage
Maximum Benefit
Annually$2,000
In-network$1,500
Out-of-network
Orthodontia
Children only50% coinsurance
w/ $1,500 lifetime maximum benefit
Implants
50% coinsurance
Not to exceed annual maximum benefit
Emergency Care
100% coverage
See EOC for limitations & exclusions
Discount on LASIK eye surgery
up to 40 - 50% off the national avg price of traditional LASIK surgery
Hearing Aids
Discount on hearing aids & follow up care
up to 64% off retail hearing aid pricingOut-of-Area Services
Subscribers
In or Out-of-State
Emergency Care*
Out-of-Country
Emergency Care*
Dependent(s)
In or Out-of-State
Emergency Care*
Out-of-Country
Emergency Care*
ID Cards
Delta does not issue ID cards; to verify benefits , please visit the Delta website
2022 How to Print ID Card.pdfDentist options
136189_EF62_Dentist terminations_v6 BS.pdfBrushSmart - Oral Wellness Program
Delta Dental - BrushSmart.pdf
