What You Need to Know
Your smile says a lot about your overall health and well-being. And your teeth provide key insight into any potential health issues. That’s why we offer two Delta Dental plans, both of which provide comprehensive coverage for you and your family.
How the Dental Plans Work
Our dental plans help you maintain a healthy smile, covering important services, such as regular preventive dental care. Choose between two plans:
- Delta Dental Platinum PPO
- Delta Dental Gold PPO
Since both plans are Preferred Provider Organizations (PPO), you have flexibility in choosing a dentist that’s within the Delta Dental network or outside of it. But you’ll pay less when you see one that’s in-network.
When you visit an out-of-network dentist, you’re still covered, but you’ll pay more because:
- You won’t qualify for reduced rates.
- Claims will be reimbursed at a lower coinsurance percentage (coinsurance is the percentage the plan pays).
- You’ll be responsible for paying the difference between what the plan pays and the amount your out-of-network dentist charges.
- You may be required to pay for services up front and file a claim for reimbursement through your plan.
Platinum PPO Benefits at a Glance
|Calendar-Year Deductible||$50 employee only/$150 family||$50 employee only/$150 family|
|Preventive & Diagnostic Services (e.g., X-rays, cleanings, exams)
Includes 3 cleanings per year
|No charge* (preventive care includes 3 cleanings per year)||No charge*|
|Basic Services||You pay 10%||You pay 20%|
|Major Services||You pay 40%||You pay 50%|
|Calendar-Year Maximum (does not apply to orthodontia expenses)||Plan pays up to $2,000||Plan pays up to $1,750|
(children and adult)
|You pay 50%||You pay 50%|
|Lifetime Orthodontia Maximum||Plan pays up to $2,000||Plan pays up to $1,750|
* Preventive care does not apply to the annual maximum.
Gold PPO Benefits at a Glance
|Calendar-Year Deductible||$50 employee only/$150 family||$100 employee only/$300 family|
|Preventive & Diagnostic Services (e.g., X-rays, cleanings, exams)||No charge (preventive care includes 2 cleanings per year)||You pay 20%|
|Basic Services||You pay 20%||You pay 40%|
|Major Services||You pay 50%||You pay 50%|
|Calendar-Year Maximum||Plan pays up to $1,500||Plan pays up to $1,250|
|Orthodontia||Not covered||Not covered|
Delta Dental of New York
Plan Number/Network: 18456/Premier Network