You may visit an in-network PPO or Premier dentist or out-of-network non-participating dentist, but the price you pay for care will differ depending on who you see. Review the Dental Plan rate sheet (page 2) to view how much you will pay for coverage.
Delta Dental does not issue ID cards, but you can setup your own account on www.deltadentalins.com and you can print an ID card. Once on the Delta Dental page, click on LOGIN at the top of the page. If you don’t remember registering previously, click register and use your SSN as your Enrollee ID and enter your name and DOB. If you already registered, you can request help retrieving your username and password by clicking the links on the webpage.
To file a claim for out-of-network expenses, you will need to log into your account at www.deltadentalins.com, then download and mail a completed claim form.
In-Network and Out-of-Network Dentists
- If you visit an in-network PPO or Premier dentist, you will pay less for care, and you won’t need to submit a claim form. Delta Dental offers the smaller “PPO” network of providers who will give you the greatest discount as well as the larger “Premier” network. To find an in-network provider, visit www.deltadentalins.com or call 1-800-932-0783.
- If you visit a non-participating dentist and the charge is more than the maximum plan allowance, you will pay 100% of the amount that exceeds that limit, in addition to any applicable deductible and coinsurance amounts. You must pay the dentist up front and submit a claim for reimbursement to Delta Dental.
| PPO or Premier Network Dentist | Non-Participating / Out of Network Dentist*** | |
|---|---|---|
| Annual deductible |
$50/person
$100/family
|
$50/person
$100/family
|
| Annual maximum benefit | $2,000; combined in- and out-of-network | $2,000; combined in- and out-of-network |
|
Preventive and diagnostic services
(cleanings, X-rays, and fluoride treatments for children)
|
Plan pays 100%, no deductible | Plan pays 100%, no deductible |
|
Basic restorative services
(fillings, oral surgery, root canals, periodontics, denture repair, and relining)
|
Plan pays 80% after deductible | Plan pays 80% after deductible |
|
Major restorative services
(services related to inlays, onlays, crowns, bridges, implants, and dentures)
|
Plan pays 50% after deductible | Plan pays 50% after deductible |
| Orthodontia (for dependents up to age 19) | Plan pays 50% after deductible | Plan pays 50% after deductible |
| Separate lifetime orthodontia maximum | $1,500**; combined in- and out-of-network | $1,500**; combined in- and out-of-network |
* All benefit payments are based on the maximum plan allowance as determined by Delta Dental. You are responsible for all costs above the maximum plan allowance.
** The maximum lifetime benefit for orthodontia services includes any prior coverage provided under any of the previous Company dental plans.
*** For out of network providers, you must pay the out of pocket costs yourself and submit for reimbursement from Delta Dental. Reimbursement will be paid directly to you.
Out-of-network dentists can bill for any amounts above the Delta Dental network rate. Please request a pre-treatment estimate for any dental work that is estimated to exceed $300, so you will know what your out-of-pocket payment will be in advance of the start of treatment.