Dental
Delta Dental PPO coverage helps you maintain a healthy smile with preventive care, basic services, and major procedures. You can visit any licensed dentist, but you’ll save the most when you use an in-network provider who has agreed to discounted rates. Out-of-network dentists may charge more than the plan’s allowed amount, and you may be responsible for the difference. You plan covers preventive services—such as exams, cleanings, and X-rays—at 100% when you stay in-network, making regular checkups an easy way to protect your oral health and avoid costly issues.
DeltaCare USA HMO coverage offers affordable dental care from in-network dentists only. Your plan offers transparent out-of-pocket costs that you can review ahead of visiting your provider. You must select a primary care dentist from the listing of in-network providers that are accepting new patients. We recommend that you review providers carefully before selecting the DeltaCare USA HMO plan.
Delta Care USA HMO
Benefit Highlights
In-Network
Deductible (Individual/Family)
None
Annual Plan Max (Individual/Family)
Unlimited
Preventive Care
Covered at 100%
Basic Services
See Schedule of Benefits
Major Procedures
See Schedule of Benefits
Orthodontia (Adults and Children)
See Schedule of Benefits
Plan Cost (Semi-Monthly)
Full-Time
Employee Only: $0.00
Employee + One: $5.00
Employee and Family: $10.00
Part-Time
Employee Only: $5.00
Employee + One: $11.00
Employee and Family: $15.00
Delta Dental PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$25/$75
Annual Plan Max (Individual/Family)
$1,750 per person
Preventive Care
Covered at 100%
Basic Services
You Pay 20%
Major Procedures
You Pay 50%
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $1,500 per individual; deductible waived
Out-of-Network
Deductible (Individual/Family)
$25/$75
Annual Plan Max (Individual/Family)
$1,750 per person
Preventive Care
Covered at 100%
Basic Services
You Pay 20%
Major Procedures
You Pay 50%
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $1,500 per individual; deductible waived
Plan Cost (Semi-Monthly)
Full-Time
Employee Only: $12.50
Employee + One: $26.00
Employee and Family: $36.00
Part-Time
Employee Only: $23.00
Employee + One: $36.50
Employee and Family: $51.50