Type of Plan | Plan pays your chosen dentist a monthly fixed rate to provide services as needed. | Fee-for-service plan. Plan
provides reimbursement for services rendered. | Plan provides maximum
benefit when you visit an in-PPO network dentist. |
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Dental Providers | Must select a dental
provider affiliated with the prepaid plan. | Any licensed dentist.
However, out-of-pocket expenses may be lower when visiting a Delta Dental PPO
dentist. | Any licensed dentist, but
maximum benefit when visiting a PPO network dentist. If an out-of-PPO network
dentist is used, benefits are lower. |
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Othordontic Providers | Must use orthodontist
affiliated with the prepaid plan. | May visit any orthodontist.
However, out-of-pocket expenses may be lower when visiting a Delta Dental PPO
dentist. | Must visit an in-PPO
network orthodontist to receive maximum benefit. |
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Changing Providers | May change to another
dentist affiliated with the plan, with prior approval. | May change dentist at any
time. | May change dentist at any
time. |
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Deductibles | No deductible. | Basic: $50 per person, up to $150 annual maximum per family. Enhanced: $25 per person, up to $100 annual maximum per family. | $25 per person, up to $100 annual maximum per family, for PPO network dentists. $75 per person up to $200 annual maximum per family for non-PPO network dentists. |
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Co-payments | Co-payments for certain
covered procedures. May require payment at time of treatment. | You pay only the co-payment and any deductibles and charges above the annual maximum for covered services when visiting a Delta Dental dentist. When visiting a non-Delta Dental dentist, you also pay the difference between the dentist's submitted charges and Delta Dental's approved fees. | You pay only the co-payment and any deductibles and charges above the annual maximum for covered services when visiting a Delta Dental dentist. When visiting a non-Delta Dental dentist, you also pay the difference between the dentist's submitted charges and Delta Dental's approved fees. |
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Plan Payments | Plan pays dentist’s monthly
contract fee. | Payments based on Delta
Dentist contracted fees or the maximum plan allowance when non-Delta Dental
dentists are used. | Payments based on Delta
Dentist contracted fees or the maximum plan allowance when non-Delta Dental
dentists are used. |
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Maximum Benefits per Calendar Year | No maximum. | Basic: $2,000 for employee, $1,000 per dependent. Enhanced: $2,000 for employee and each eligible dependent. | $2,000 for employee, $2,000 per eligible dependent when PPO network dentists are used. $1,000 for employee, $1,000 per eligible dependent when non-PPO network dentists are used. |
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Implant Benefits | Premier Access and Western
Dental only. | Not a covered benefit. | Maximum lifetime benefits
of $2,500 for each employee and dependent, if using a PPO plan provider. |
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