90% 10% . . Delta Dental PPOTM Delta Dental Premier® Non Network BENEFIT PAID (% PLAN PAYS) ENHANCED BENEFIT Applies when you have had at least one routine cleaning and/or preventive oral exam in the past 12 months. Applies when you. Other Oral Surgery - dental surgery 50% 50% 40% Major Services Major Restorative Services - crowns 50% 50% 30% Prosthodontic Services - bridges, implants, dentures, and crowns over implants 50% 50% 30% Orthodontic Services Orthodontic Services - braces 60% 60% 40% Orthodontic Age Limit - Banding must begin prior to age 19. Any payment made by Delta Dental for services received from a Non-Participating Provider may be paid to the Provider or directly to the Subscriber. TM. Examples of Covered Services and Co-Insurance Levels: Co-Insurance Type 1 Preventive (No Waiting Period) . Preventive services are included in this tool. 70-80% minor preventive services (fillings, dental sealants) 50-70% major services (dental crowns, bridges, and implants) When it comes to seeking treatment for your oral health, whether it is preventive care or major restorative services, it is best if you see a Delta Dental dentist. YES. Oral Surgery Services - extractions and dental surgery 80% 80%80% Other Basic Services - misc. The Classic Plan covers most major procedures, and is backed by Delta Dental's large network and outstanding service. Basic services (routine dental procedures) are usually covered as a slightly lower percentage (typically 50 to 80%). plans are built on the value that comes from the nation's largest dental network. Delta Dental will make additional payments as follows: Delta Dental will pay 60% of the per monthly fee charged by your Full coverage dental insurance plans are those that help cover the costs of a wide range of dental treatments and procedures including preventive care, basic care, major restorative care, and sometimes, orthodontic treatment.Having a full coverage plan does not necessarily mean your plan will cover 100% of the costs associated with your oral health journey, however. 50%* BASIC BENEFIT. Delta Dental's individual plans include: Up to 100% coverage for checkups, cleanings and preventive procedures. Major Restorative Services No Waiting Period Posterior composite resin fillings Amalgam Benefit Crowns and Prosthetic Services, . Major restorative services - crowns 50% 50% 50% Oral surgery services - extractions and dental surgery 50% 50% 50% Endodontic services - root canals 50% 50% 50% . Call Delta Dental Customer Service at (800) 971-4108 (mention HAP group #2195). $1,000. This provides all the Deductible per calendar year. One bitewing x-ray per year. Services and Major Services. Delta Dental Pays 100% 100% 100% 60% 100% Basic Restorative Fillings, extractions, periodontal maintenance, denture repair, crown lengthening and emergency palliative treatment Delta Dental Pays 80% after a 6-month waiting period root canal therapy is included in this category under the Traditional Plan) Delta Dental Pays 70% after a 3-month Major restorative procedures: 50% of the negotiated rate Orthodontia 50% of the negotiated rate Non-Network: Delta Dental Premier or non Delta Dental providers Preventive and diagnostic: 100% of Premier dentist fee or 80% program allowance Basic procedures: 60% of Premier dentist fee or program allowance Delta Dental is a dental insurance company with over 80 million members and a . Major Restorative Services - crowns . There's an Individual and Family Plan for YouUp to 100% coverage for checkups, cleanings and preventive proceduresUp to 80% coverage for fillings and most other basic restorative servicesUp to 50% coverage for major restorative, such as denturesAccess to Delta Dental's participating dentist networks. Major Restorative Services No Waiting Period Posterior composite resin fillings Amalgam Benefit Crowns and Prosthetic Services, including Bridges and Dentures . The Classic Plan covers most major procedures, and is backed by Delta Dental's large network and outstanding service. Delta Dental PPO, Maximum Allowable Charge (MAC) Plan Schedule of Benefits . Plan Diagnostic and Preventive Care Basic Restorative Care Major Restorative Care Emergency Services Orthodontics DELTA DENTAL PREMIER In-network 100% coverage 80% You may also write us at: P.O. Antibiotic drug injections are Covered Services. You can review the plan features below. Major Restorative Services crowns 50% 50% 50% Relines and Repairs to bridges, dentures, and implants 50% 50% 50% . Major Restorative 4 0% . Although insurance generally covers 100% of the . Delta Dental Premier dentists—Many dentists that are not part of the Delta Dental PPO network may be in the Delta Dental Premier network. Two cleanings. This is why the kind of dental care service that you are opting for in your plan is crucial as you need one that provides you the best value for your money and at the same time takes care of your oral health. services 80% 80%80% Relines and Repairs - to prosthetic appliances 80% 80%80% Major Services Major Restorative Services - crowns 60% 60%60% Prosthodontic Services - bridges, implants, dentures, and crowns over implants 60% 60%60% You will be required to select a primary care dentist or one may be assigned to you.¹ You pay a fixed copayment for services, and except for emergencies, there is generally no coverage for out-of-network benefits. for diagnostic and preventive services, such as cleanings and exams - combined with varying levels of coverage for . 80% 80% 80% Relines and Repairs . When you receive services from a Delta Dental Premier or Non-participating Dentist, the percentages in those . If your dental insurance offers coverage for major restorative services, it will probably cover root canals. The deductible does not apply to Dental Plan Comparison For all of the dental plans, the annual maximum is $2,000 in 2021 for all benefits per person per contract year. Basic Services . Delta Dental PPO Dentist Delta Dental Premier Dentist Non-Participating Dentist; Major Restorative Services - Used when teeth can't be restored with another filling material (for example, crowns) 60%: 60%: 40%: Prosthodontic Services - Used to replace missing natural teeth (for example, bridges, implants and dentures) 60%: 60%: 40% Harvard offers dental benefits to eligible employees and dependents through Delta Dental PPO Plus Premier, which includes dentists in Delta's Premier and PPO networks. Pre-authorizations or referrals are required for certain benefit plans and certain dental care providers. DDMN-ND2621 2-100 Eligible Employees Delta Dental PPO Plus PremierTM The dollar amount of benefits paid will be limited by your policy . Included with all plans. $50 per person; (Does not apply to Diagnostic & Preventive services, such as cleanings and X-rays) An affordable plan with a traditional design. You can find the detail of what is covered in each category below the chart. 2021 and 2022 Delta Dental of Minnesota Serving North Dakota Pathfinder Plans. Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! 80% 80% 80% Other Basic Services - misc. TM . Out-of-network minor and major restorative services — minor and major restorative services are only discounted when provided by a dentist located in Massachusetts that participates with the Delta Dental PPO network. There is a six (6) month Benefit waiting period for certain services. 2021 and 2022 Delta Dental of Nebraska Pathfinder Plans. Preventive care coverage varies by plan and by demographic considerations such as age. Delta Dental for any procedure that exceeds $300. Delta Dental of Massachusetts PPO and Premier insurance products are offered by Dental Service of Massachusetts, Inc. It also covers basic and major restorative care. . Basic and major restorative services are payable by the patient at 100% of the Delta Dental PPO Contract Fee Schedule for your region and specialty. For individuals 19 years of age or older, or individuals age 18 and under seeking non-EHB covered services Delta Dental PPO (Point-of-Service) IN NETWORK OUT OF NETWORK WAITING PERIODS Delta Dental PPOTM dentist Delta Dental Premier® dentist Nonparticipating Major Restorative . • Special restorative procedures to restore lost tooth structure as a result of tooth decay or fracture. DELTA DENTAL. Delta Dental PPO dentists agree to accept Delta Dental's PPO approved amount as payment in full for covered services. Class II Services Basic Restorative, Endodontics, Periodontics, Oral Surgery Class III Services Major Restorative, Prosthodontics, Implants Class IV Services Orthodontia Revised N/A D4265, D4276 D6091, D6100 N/A Deleted N/A N/A N/A D8050, D8060, D8690 New N/A D3921 D5725, D5765 N/A Plan Year Highlights You can now You may make a complaint about Delta Dental services by email to Customer_service@ddpco.com. Access to Delta Dental's participating dentist networks. the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. between Delta Dental of Minnesota's allowable fee and the fees charged by the non-participating dentist. Box 172528 -2528 : A signed consent authorizing Delta Dental to disclose protected description under Complex or Major Restorative Services. Major Restorative Services include: inlays, crowns, bridges and dentures. Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! Orthodontic services are covered under the Health Trust Dental plan, to a lifetime maximum benefit of $1,250 per person. There is a six month waiting period on Type II services and a twelve month waiting period on Type III services. Major Restorative Care . Major Restorative Services - crowns 50% 50% 50% Relines and Rebase - to dentures 50% 50% 50% Implant Repair - implant maintenance, repair, and removal . Basic Restorative (Fillings) . 50%* Implant Coverage. A. Coverage for fillings at 50% of the payable amount. Oral Surgery Services - extractions and dental surgery 75% 75%75% Other Basic Services - misc. Major dental services, such as dentures and crown and bridge treatment, if covered, will typically be provided for at an even lower rate (possibly 50% or less). The Delta Dental PPO plus Premier plan leverages the PPO and Premier networks. Deductible - $50 deductible per person total per benefit year limited to a maximum deductible of $150 per family per benefit year on Basic Services and Major Services. Orthodontia . have not received at least one routine cleaning and/or preventative oral exam in the past 12 months. Please note: This is intended only as a summary of benefits. Diagnostic & Preventive Services 100% 100% 100%* Basic Restorative Services 80% 60% 60%* Major Restorative Services 50% 50%* Implant . Dental will make an initial payment to you or your Participating Dentist equal to Delta Dental's stated Copayment on 30% of the Maximum Payment for Orthodontic Services as set forth in this Summary of Dental Plan Benefits. 70-80% minor restorative services (i.e. services . Delta Dental PPO Plus Premier. $50 per person; (Does not apply to Diagnostic & Preventive services, such as cleanings and X-rays) An affordable plan with a traditional design. The The new 2021 Delta Dental Solutions plans have even more options to meet your employees' needs. Choose our team in Lansing, MI for restorative dental services Broken teeth, extractions and gaps between teeth can make your smile noticeable in all the wrong ways. **A 24-month missing tooth clause applies to prosthetic services. You can now receive expert Class I Services Diagnostic, Preventive Class II Services Basic Restorative, Endodontics, Periodontics, Oral Surgery Class III Services Major Restorative, Prosthodontics, Implants Class IV Services Orthodontia Revised N/A N/A D5282, D5283, D5286, D6091 N/A Deleted N/A D7960 N/A N/A New D0701, D0705, D0706, D0707, D0708, D0709 D3471, D3472, D3473, 50%. Dental Coverage at a Glance Individuals and families . DELTA DENTAL INDIVIDUAL AND FAMILY—SINGULAR Coverage . Dentist Directory (Delta Dental PPO and/or Delta Dental Premier) on the Internet at www.DeltaDentalOK.org; or call Delta Dental of Oklahoma's customer service department at 405-607-2100, or toll-free at 1-800-522-0188. The dollar amount of benefits paid will be limited by your policy . Through our partnership with Delta Dental of Ohio, this coverage includes access to the Delta Dental Medicare Advantage PPO Network and features the following benefits: $0 office visit copay. 135PPO 0721 Page 4 of 4 July 1, 2022 These dental benefits are designed to make you the employer of choice. Occlusal guards are not Covered Services. Major Services Major Restorative Services - crowns 25% 25% 0% Relines and Repairs - to prosthetic appliances 25% 25% 0% Prosthodontic Services - bridges, implants, and . Major Restorative Services No Waiting Period Posterior composite resin fillings Amalgam Benefit Crowns and Prosthetic Services, . Delta Dental PPO is the dentist network for this plan. Delta Dental of New Jersey is a part of Delta Dental Plans Association. *When dentists agree to become part of Delta Dental's PPO or Premier network, they agree to accept established fees for services, and cannot . Delta Dental's payment for Orthodontic Services will not exceed a lifetime maximum of $1,125 per eligible person. Return to General Information: Complaints, Grievances & Appeals : Member Appeals Mailing Address: Delta Dental of MA PO BOX 2907 Milwaukee, WI 53201 Fax Number: 617-886-1199 (WI) Provider Appeals and Grievances: Delta Dental of . services? Delta Dental of Kansas offers fully insured dental plans for individuals and families! If the member does not receive preventive dental services every year, benefits will reduce to Year 1 co-insurance benefits. DENTAL PLANS Harvard's dental plan covers preventive, basic, restorative, major, and orthodontic services. Delta Dental's Veterans Affairs Dental Insurance Program provides you and your family with comprehensive dental protection at an affordable cost. Delta Basic services (routine dental procedures) are usually covered as a slightly lower percentage (typically 50 to 80%). This provides all the benefits of Delta Dental PPO plan with a plus—members that visit a dentist in the Premier network still receive the benefit of that dentist's contracted fee. Customer Service Toll-Free Number: 800-223-3104 www.DeltaDentalTN.com May 2, 2017 Major Restorative Services-crowns 60% 60% 60% Relines and Rebase- to dentures 60% 60% 60% Prosthodontic Services - bridges and dentures 60% 60% 60% Implants - endosteal implants to replace missing teeth Solutions 1000. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. Major dental services, such as dentures and crown and bridge treatment, if covered, will typically be provided for at an even lower rate (possibly 50% or less). Major Restorative Services. Delta Dental to disclose protected health information to the external reviewer. Major Restorative Services - crowns Occlusal Adjustment - occlusal equilibration Adjustments and Repairs - to bridges, im-plants and dentures Prosthodontic Services - bridges, implants, . Up to 50% coverage for major restorative, such as dentures. Lab Fees are paid to the treating office quarterly, for major restorative services like crowns, dentures and bridges. Get a Quote. In dental insurance, major work falls into the most extensive of the three groups used to categorize most dental care: Preventative Services: Diagnostic and preventive services, such as cleanings and X-rays; Basic Services: Basic restorative care, such as fillings and extractions; Major Services: Major restorative care, such as root canals and . major restorative services, such as fillings and crowns - this means you can choose the plan that's right . Major restorative services—crowns 50% 50% 50% None. Delta Dental PPO Schedule of Benefits for PULASKI COUNTY EMPLOYEES/COUNTY JUDGE Effective Date: 02/01/2004 12:01 a.m. Central Standard Time Group Number: 2292-01000000 Deductible: Applies to Basic Restorative Services and Major Restorative Services per benefit period. **A 24-month missing tooth clause applies to prosthetic services. The waiting . Crown Repair, Major Restorative Services, Relines and Repairs, TMD Treatment and Prosthodontic Services will not be covered until after a person is enrolled in the dental plan for six (6) consecutive months. 1 . Delta Dental of Minnesota does not determine whether a service submitted for payment or benefit under this Plan is a dental procedure that is dentally necessary to treat a specific condition or . TYPE OF DENTAL SERVICES CLASSIC CHOICE DENTAL Major Restorative Services • Emergency services - major procedures. Please contact the Health Trust at 1-800-852-8300 for . Any payment made by Delta Dental for services received from a Non-Participating Provider may be paid to the Provider or directly to the Subscriber. 50% 50% . Dental coverage provides benefits for preventive care like exams and cleanings. Endodontics (Root Canal Therapy) Periodontics (Gum Disease Treatment) Major Services . Dental insurance plans often describe dental services in three classes of service: Class 1: Preventative and diagnostic care, such as x-rays and cleanings. . * Payment is made to you for diagnostic and preventative services at 80% of your Delta Dental Premier contract fees. Daniel A. Woodland DDS can restore the smile you were meant to have using dental crowns, dental bridges or dentures. Get a Quote. Should you require specialty services, you may select a specialist from the PPO services 75% 75%75% Relines and Repairs - to prosthetic appliances 75% 75%75% Major Services Major Restorative Services - crowns 50% 50%50% Prosthodontic Services - bridges, implants, dentures, and crowns over implants 50% 50%50% Deductible per calendar year. The waiting period is 12 months for major restorative (Comprehensive and Prime; Enhanced not covered), endodontics (all plans), periodontics (all plans), oral surgery³ (all plans) and . Major Restorative - Crowns, bridges, oral surgery, etc. You are encouraged to obtain a predetermination of benefits from Delta for services greater than $300, or for crowns or bridges. Major Restorative Services - crowns 50% 50% 50% Relines and Repairs - to bridges, dentures, and implants 50% 50% 50% . waived, your coverage on a comparable Delta Dental of Massachusetts plan would need to have terminated for no more than 60 days prior to the effective date of your Delta Dental Individual and . Diagnostic & Preventive Services 100% 100% 100%* Basic Restorative Services 80% 60% 60%* Major Restorative Services 50% 50%* Implant Coverage . dental crowns, tooth extraction, dental implants) Seeing as your responsibility for preventive care is most likely going to be $0, your dental insurance company implores you to maintain your six-month checkups and cleanings to avoid future problems. Delta Dental based upon your projected course of treatment. Delta Dental PPOTM Delta Dental Premier® Out-of-Network BENEFIT PAID (% PLAN PAYS) ENHANCED BENEFIT Applies when you have had at least one routine cleaning and/or preventive oral exam in the past 12 months. Applies to Child Orthodontic Services per Benefit Period. Send appeals to Delta Dental, P.O. All . Visit a PPO dentist to maximize your savings. Class 3: Major restorative care, including dentures, bridges, and crowns. ** You Will Not Receive an ID card ** Dentists verify eligibility with your Name, Date of Birth & Social Security Number Delta Dental Customer Service Delta Care 1-800-422-4234 Delta PPO + Premier 1-888-335-8227 www.deltadentalins.com Use Delta Dental's website to . services 70% 70% 70% Major Services Major Restorative Services - crowns 50% 50% 50% Relines and Repairs - to prosthetic appliances 50% 50% 50% Prosthodontic Services - bridges, implants, dentures, and crowns over implants Periodontic Services - to treat gum disease 50% 50% 50% Oral Surgery Services - extractions and dental surgery 50% 50% 50% Major Restorative Services - crowns 50% 50% 50% Other Basic Services - misc. Shop now. You are only responsible for your coinsurance. dental fillings) 50-70% major restorative services (i.e. Refer to your benefit plan to determine whether these requirements apply to you. The Company offers you two dental options administered by Delta Dental of Illinois*, or you can decline coverage: Both options cover the same services, but the Buy-up option has a higher calendar year maximum . This will enable us to help you estimate any out-of-pocket expenses you may incur. Delta Dental PPO Plus Premier. (calendar-year, does not apply to diagnostic/preventive services) $50 $50 $25 $25 Annual Plan Maximum Per Person (calendar-year) $750 $750 $1,500 $1,500 SingularDental . We pay a set amount per procedure* . Delta Dental PPO Value Plan maintains a panel of specialists. Generally, every dental insurance policy covers most of the preventive services, fewer basic services and the least amount of major services. Basic Restorative Care . Box 9695, Boston, MA 02114. In accordance with the agreed upon payment plan, Delta Dental will make an initial payment to you or your Participating Dentist equal to Delta Dental's stated Copayment on 30% of the Maximum Payment for Orthodontic Services as set forth in this Summary of Dental Plan Benefits. In-network basic and major restorative services —like fillings, crowns, and root canals are available to you at negotiated discount rates . Oral Surgery Services - extractions and dental surgery 70% 70% 70% Other Basic Services - misc. Dental. . Four plan options with coverage . The DeltaCare USA (DHMO) plan, in most states, operates through a network of participating dentists who manage all of your dental care. 60% 40% . Major Restorative Services -crowns 50% Relines and Repairs -to bridges, implants, and dentures 50% TMD Treatment -treatment of the disorder of the This plan pays most benefits at a percentage. Delta Dental PPO (Point-of-Service) Summary of Option 3 Dental Plan Benefits For Group# 5970-3001, . To find a participating dentist for Delta Dental Individual and Family - PPO Value for Seniors: • Crowns, when the amount of lost tooth structure does not enable the placement of a filling material. Dental Plan Group Numbers: Delta Dental PPO: 6100 Delta Dental Premier: 6090 Benefit Questions You can reach the Office of Human Resources Contact Center at 612-624-8647 or 1-800-756-2363, select option 1, or email benefits@umn.edu. To find a participating dentist for Delta Dental Individual and Family - PPO Value for Seniors: Two exams. These services are covered at 50% of Reasonable & Customary charges, and are not subject to the deductible. Up to 80% coverage for fillings and most other basic restorative services. Major restorative services—crowns 50% 50% 50% 12 months TMD treatment—treatment of the disorder of the temporomandibular joint, including related films Out-of-network minor and major restorative services — minor and major restorative services are only discounted when provided by a dentist located in Massachusetts that participates with the Delta Dental PPO network. • If a claim is denied, you can request an appeal by writing to Delta Dental within 180 days of receiving notice on the claim. Class 2: Basic restorative care, including fillings and root canals. 50%. $1,000. services 50% 50% 50% Relines and Repairs - to bridges, implants, and dentures 50% 50% 50% Major Services Type B: Basic Restorative (fillings, extractions) 80% 80% Type C: Major Restorative (bridges, dentures, crowns, periodontics) 50% 50% Deductible† Per Individual $50 $50 Annual Maximum Benefit Per Individual (dental exams, bitewing x-ray, fluoride, and prophy/cleanings do not apply to individual coverage limit) $2,000 $2,000 Prosthodontics (Dentures, Bridges) Special Restorative (Crowns, Onlays) 50% of PPO Provider's Allowable Fee DENTIST PAYMENTS The Delta Dental PPO plus Premier plan leverages the PPO and Premier networks. The patient may be billed the balance up to your submitted charge. 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