Loading...
HomeMy WebLinkAboutDelta Dental At A GlanceKeep smiling Delta Dental PPO™ Save with PPO Visit a dentist in the PPO1 network to maximize your savings.2 These dentists have agreed to reduced fees, and you won’t get charged more than your expected share of the bill.3 Find a PPO dentist at deltadentalins.com. Set up an online account Get information about your plan, check benefits and eligibility information, find a network dentist and more. Sign up for an online account at deltadentalins.com. Check in without an ID card You don’t need a Delta Dental ID card when you visit the dentist. Just provide your name, birth date and enrollee ID or Social Security number. If your family members are covered under your plan, they’ll need your information. Prefer to have an ID card? Simply log in to your account to view or print your card. Coordinate dual coverage If you’re covered under two plans, ask your dental office to include information about both plans with your claim — we’ll handle the rest. Understand transition of care Generally, multi-stage procedures are covered under your current plan only if treatment began after your plan’s effective date of coverage.4 Log in to your online account to find this date. Get LASIK and hearing aid discounts With access to QualSight and Amplifon Hearing Health Care5, you can receive significant savings on LASIK procedures and hearing aids. To take advantage of these discounts, call QualSight at 855-248-2020 and Amplifon at 888-779-1429. Save with a PPO dentist PPO NON–PPO 1 In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan. 2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. Network dentists are paid contracted fees. 3 You are responsible for any applicable deductibles, coinsurance, amounts over annual or lifetime maximums and charges for non-covered services. Out-of-network dentists may bill the difference between their usual fee and Delta Dental’s maximum contract allowance. 4 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for any costs. Group- and state-specific exceptions may apply. If you are currently undergoing active orthodontic treatment, you may be eligible to continue treatment under Delta Dental PPO. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan. 5 Vision corrective services and Amplifon’s hearing health care services are not insured benefits. Delta Dental makes the vision corrective services program and hearing health care services program available to you to provide access to the preferred pricing for LASIK surgery and for hearing aids and other hearing health services. West Virginia: Learn about our commitment to providing access to a quality dentist network at deltadentalins.com/about/legal/index-enrollee.html.Copyright © 2023 Delta Dental. All rights reserved. HL_PPO #135419F (rev. 1/23) Benefit Highlights: Delta Dental PPO Otay Water District 22719 Effective Date: 1/1/2025 This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative. 560 Mission St., Suite 1300 888-335-8227 P.O. Box 997330 San Francisco, CA 94105 deltadentalins.com Sacramento, CA 95899-7330 For eligibility details, refer to the plan's Evidence/Certificate of Coverage (on file with your benefits administrator, plan sponsor or employer). * Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees. ** Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists. Delta Dental of California Customer Service Claims Address Orthodontic Maximums $500 Lifetime $500 Lifetime $500 Lifetime Orthodontic Services 50%50%50%Adults and Dependent Children Major Services 60%50%50%Crowns, Inlays, Onlays and Cast Restorations Prosthodontics 60%50%50%Bridges, Dentures and Denture Repair/Reline/ Rebase, Implants Oral Surgery 90%80%80% Endodontics 90%80%80%Root Canals Periodontics 90%80%80%Surgical and Non-Surgical Periodontics Diagnostic & Preventive Services (D&P) 100%100%100%Exams, Cleanings, X-Rays, Sealants and Space Maintainers Basic Services 90%80%80%Fillings and Simple Extractions D&P counts toward maximum? Yes, for all Dentists Covered Services*Delta Dental PPO Delta Dental Premier Non-Delta Dental dentists** dentists**dentists** Deductibles waived for Orthodontics?Yes, for all Dentists Maximums $2,000 $2,000 $2,000Per member each calendar year Deductibles $50/ $150 $50/ $150 $50/ $150per member / per family each calendar year Deductibles waived for Diagnostic & Preventive?Yes, for all Dentists Plan Benefit Highlights for: Group Number: Benefits Delta Dental PPO Delta Dental Premier Non-Delta Dental dentists** dentists**dentists** TM Revised 09/25/2024