October 23, 2014 Sign inRegister

Delta Dental PPO Plan


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Delta Dental PPO Options

Groups with 5 - 99 Subscribers
Co-Insurance Options Calendar Year


(Individual/Family)
Waived for Class I
Calendar Year Ortho or Composite
PPO Network Premier Network* Deductible Option Maximum Options Additional Coverage Options

100/90/60
100/90/50
100/80/50
80/80/50


100/80/60
100/80/50
80/70/40
70/70/40

$0/$0
$25/$75
$50/$150
$75/$225
$100/$300

$750
$1,000
$1,500
$2,000
$2,500
$3,000

Orthodontia:
Children OR
Adult and Children
(Minimum Group Size 10)
$1,000
$1,500
$2,000

Posterior Composites

*If nonparticipating charges are more than Delta Dental maximum allowable fees, the employee is responsible for paying the balance

Delta Dental Benefit Highlights:

  • Cover up to four periodontal cleanings a year under certain qualifying periodontal circumstances
  • Periodontal cleanings are covered under Class I
  • Endodontic and Periodontics are covered under Class II
  • Fluoride and sealant coverage for both adults and children
  • Deductible waived for Class I services
  • No "missing tooth clause" or pre-existing conditions
  • No late entrant penalties or waiting periods
  • TMJ coverage included - $1,000 annual maximum and $5,000 lifetime maximum
  • Implant coverage included
  • Dependents are eligible for benefits through age 25

Underwriting Guidelines


Eligibility
  • Coverage is available to employees working a minimum of 20 hours per week or 80 hours per month

Contributions
  • Employer must contribute at least 50 percent of the employee premium
  • No employer contribution is required toward the dependent premium

Participation
  • Employee participation for groups with 5 to 9 enrolled subscribers is 100 percent of all eligible employees or tied to the company's medical plan (groups' decision)
  • Dependent participation for groups with 5 to 9 enrolled subscribers must be the same as the employee
  • Employee participation for groups with 10 to 99 enrolled subscribers is 75 percent enrollment of all eligible employees
  • Dependent participation for groups with 10 to 99 enrolled subscribers is 50 percent of all eligible dependents
Rate Guarantee
  • One-year rate guarantee

Click here to view PDF version of information above. Please contact your Sales Executive on groups with 100 or more enrolled subscribers for plan options

 

Questions?  Click Here to find contacts and system information. 
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