Dental
Dental coverage provides periodic preventive care and, if there’s a problem, helps with the cost of dental work.
Delta Dental PPO
Plan Information
Plan Name: Delta Dental PPO
Policy Number: 19045
Effective Date: 01/01/2025
Provider Network: Delta Dental
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$50/$150
Plan Maximum
$2,000
Preventive Care
$0 (coverage limited to 2 times per calendar year)
Basic Services
20% after deductible
Major Procedures
40% after deductible
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,000 per individual; deductible waived
Out-of-Network
Deductible (Individual/Family)
$50/$150
Plan Maximum
$2,000
Preventive Care
$0 (coverage limited to 2 times per calendar year)
Basic Services
20% after deductible
Major Procedures
40% after deductible
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,000 per individual; deductible waived