Dental Plan
Healthy teeth and a bright smile depend on practicing prevention and proactive dental care. When you elect dental coverage through Delta Dental, you have access to a variety of online tools and programs as well as access to a large network of dentists who will help manage your comprehensive care.
Finding In-Network Providers
Remember to visit in-network dentists to receive the deepest level of discount.
To find in-network dentists, visit Delta Dental Dentist Login | Dentist Network Information or call 800-524-0149.
Examples of services
- Preventive—exams, cleanings, flouride, X-rays and sealants
- Basic—fillings, extractions, periodontics, repairs and oral surgery
- Major—crowns, inlays, dentures and dental implants
| Coverage Type |
In-Network Provider % of Negotiated Fee |
Non-Network Provider % of R&C Fee |
|
|---|---|---|---|
|
Type A: Preventive |
100% | 100% | |
|
Type B: Basic Restorative |
80% | 80% | |
|
Type C: Major Restorative |
50% | 50% | |
|
Type D: Orthodontia |
50% | 50% | |
| Deductible | |||
| Individual | $50 | $50 | |
| Family | $150 | $150 | |
| Annual Maximum Benefit | |||
| Per Person | $1,750 | $1,750 | |
| Orthodontia Lifetime Maximum—Ortho applies to Adult and Child (up to dependent age limit) |
|||
| Per Person | $1,500 per Person | $1,500 per Person | |
| Dependent Age | |||
When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental’s Nonparticipating Dentist Fee that will be paid for those services. This amount may be less than what the dentist charges and you are responsible for that difference. Please confirm fees with your provider prior to service, or have your provider submit a Pre-Determination request, so you are aware of the charges prior to having the service completed.
| FTE | W2T | |
|---|---|---|
| Employee | $8.12 | $17.41 |
| Employee + Spouse | $16.41 | $35.20 |
| Employee + Child(ren) | $19.88 | $42.66 |
| Employee + Family | $30.31 | $65.03 |
Please note: Delta Dental does not mail out physical cards to new participants. When visiting your dentist, please advise them of your Delta Dental insurance and they can verify coverage with your Social Security number.
Delta Dental
Call: 800-524-0149
deltadentaloh.com
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