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Delta Dental PPO™ Individual Premium Plan

Find plan availability & pricing in your area by entering in your ZIP code below:

Questions? Call 1-877-242-1463

Delta Dental PPO Individual - Premium Plan

  • Annual Deductible - $50 per person, $150 family
  • Annual Maximum Benefit - $1,500 per person

Program Summary

Delta Dental PPO Individual Premium Plan is a plan that covers a percentage of your costs for covered dental services. Once you enroll, you’ll get coverage for diagnostic and preventive care, including exams, cleanings and x-rays. Plus the premium plan also includes specialty coverage for implants, crowns and root canals. ***Plus, receive savings on LASIK eye surgery through Qualsight and hearing benefits through Amplfon.

  • Get 100% coverage for essential preventive dental care plus additional benefits after 6 months.
  • Covered diagnostic and preventive services at 100%
  • Covered basic services at 80% with in-network providers (after deductible)
  • Covered major services at 50% with in-network providers (after deductible)
Benefit In-network Out-of-network
Individual Annual Deductible $50 Per Person $50 Per Person

Family Annual Deductible

$150 Per Family $150 Per Family
Annual Benefit Maximum $1,500 Per Person $1,500 Per Person

Delta Dental PPO™ Individual Premium Plan

Find plan availability & pricing in your area by entering in your ZIP code below:

Enter Your ZIP Code to View Dentist Listing:

Plan Highlights

Eligibility
Primary enrollee, spouse or domestic partner, eligible dependent children up to age 26.
**Please consult the plan policy for descriptions
Deductibles and Maximums
Calendar Year Deductible $50 Per enrollee
  $150 Per family
Annual Maximum per Calendar Year $1,500 Per enrollee
Orthodontic Deductible $50 Per enrollee
Orthodontic Lifetime Maximum $1,500 Per enrollee
Covered Services Delta Dental
PPO dentists
Non-Delta Dental
PPO dentists
Diagnostic and Preventive (D&P) Services
Exams, cleanings, x-rays and sealants
100% 100%
Basic Services
Fillings, emergency treatment to relieve pain
80% 80%
Cosmetic Services
Teeth whitening and mouth/night guards
80% 80%

Endodontics
Root canals

50% 50%
Periodontics
Gum treatments
50% 50%
Oral Surgery
Tooth extractions
50% 50%
Prosthodontics
Bridges, dentures, implants
50% 50%
Major Services
Crowns, inlays, onlays, cast restorations
50% 50%
Orthodontics
Adults and dependent children
50% 50%
Waiting Periods
Diagnostic and Preventive Services None
Basic Services 6 Months
Major Services 12 Months
Orthodontics 12 Months

Reimbursement is calculated based on maximum contract allowances. This benefit information is only a summary and is not intended or designed to replace or serve as the plan Policy. Limitations and/or waiting periods may apply for some benefits; some services may be excluded from the plan.

Delta Dental PPO™ Individual Premium Plan

Find plan availability & pricing in your area by entering in your ZIP code below:

Additional Plan Information For Delta Dental PPO Individual Premium Plan

Annual Maximum

This is the total amount per person your plan will pay toward the cost of dental care each year.

  • $1500, per enrollee on the plan

 

Calendar Year Deductible

This is the amount you must pay per person each year before your plan starts making payments for services. There is a separate deductible for orthodontics.

  • Individual - $50
  • $150 annual deductible for families.
  • Family $150

 

Choose any dentist

Visit any licensed dentist, anywhere. You'll generally save the most by visiting a dentist from our PPO network. These dentists agree to reduced fees, and won’t charge you more than your expected share of the bill. They also complete your claim forms and can advise you on questions about your share of the payment. You can use Find a Dentist on this page to easily locate a PPO dentist.

Delta Dental PPO™ Individual Premium Plan

Find plan availability & pricing in your area by entering in your ZIP code below: