Uniform Dental Plan #09600
You have chosen the Uniform Dental Plan (UDP)
GROUP #03000
| UNIFORM DENTAL PLAN |
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You pick your dentist from the largest provider networks: state and national |
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Get specialist care without a referral |
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Deductible waived for preventive care-you pay $0 |
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Deductible & coinsurance apply for other treatments |
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Deductible & coinsurance apply for other treatments |
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Coverage for out-of-network care |
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Responsive, local customer service |
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COINSURANCE: On the UDP (PPO) plan, you pay a percentage of treatment costs, the plan pays the rest.
Here's how to get the most from your coverage
| Easy, secure access to all your custom dental benefit information on your phone or desktop! |
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View and print your ID card |
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View your custom coverage overview, claim status and benefits usage |
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Get instant out-of-pocket estimates on your dentist and your plan |
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Review your Explanation of Benefits (EOB) |
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See how much of your annual maximum you have left to spend |
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And more |
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STEP 2
Find a Delta Dental PPO dentist to get the best savings
| Check that your dentist is in-network or find a new PPO dentist |
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Find a Dentist Tool |
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Select 'Delta Dental PPO' to filter your search results |
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Contact the dental office to confirm they're accepting new patients |
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STEP 3
Review your DeltaCare® costs
| ANNUAL COSTS |
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Deductible
(amount you pay before your plan pays) |
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$50 / person
$150 / family |
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Plan maximum
(amount your plan pays towards the cost of your dental care during the plan year) |
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$1,750 |
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| YOU PAY AFTER DEDUCTIBLE |
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| Cleaning and exam every 6 months |
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0% |
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| Complete x-rays every 3 years |
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0% |
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| Root canals (endodontics) |
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20% |
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| Treatment of gum disease (periodontics) |
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20% |
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| Orthodontics |
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50% until you reach lifetime annual maximum of $1750; patient is responsible for any amount exceeding the liftime annual maximum |
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| Nonsurgical TMJ |
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30% of costs until the plan has paid $500 (for PPO, out of state, and non-PPO providers); then any amount over $500 in the member's lifetime (maximum lifetime benefit) |
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| This is a summary of UDP plan benefits. Please review the PEBB UDP certificate of coverage below for more information about your plan. |
