We partner with Delta Dental to offer you and your family members dental insurance. Visit deltadentaloh.com to find a broad group of in-network dental providers and access a variety of online tools and programs.
You have two options to choose from: the Delta Dental (Low Plan PPO) or the Delta Dental PPO Plus Premier (High Plan PPO).
| Delta Dental | ||||
|---|---|---|---|---|
| Low PPO | High PPO | |||
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Annual Deductible | ||||
| Individual | $50 | $75 | $50 | $50 |
| Family | $150 | $225 | $150 | $150 |
| Annual Maximum | ||||
| $1,000 | $1,000 | $1,500 | $1,500 | |
| Coinsurance | ||||
| Preventive | 100% | 90% | 100% | 100% |
| Basic | 80% | 60% | 90% | 80% |
| Major | 50% | 40% | 60% | 50% |
| Orthodontia** | ||||
| Coinsurance | N/A | N/A | 60% | 50% |
| Ortho Limit | N/A | N/A | $1,200 | $1,200 |
*When you receive services from a non-participating dentist, the percentages in the Out-of-Network columns indicate the portion of Delta Dental’s non-participating 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.
**Child(ren) up to age 19 eligible only
Child(ren)’s eligibility for dental coverage is from birth up to age 26.
This is a high-level summary of your benefit coverage. Full coverage details are available in your Certificate of Insurance (COI). In the event there is a discrepancy between what is reflected in this guide and what is communicated in your COI, the terms of your COI will prevail.
Finding In-Network Providers
Remember to visit in-network dentists to receive the deepest level of discount on your services.
To find a participating in-network dentist in your area, click here or call 800.542.0149.
Orthodontia Services Note
The lifetime maximum illustrated is different from the calendar year maximum. For orthodontia services, this limit does not reset each year, this is the most your plan will cover for your services for the lifetime of your participation in this program.
Examples of Services
Preventive — exams, cleanings, fluoride, x-rays, and sealants
Basic — fillings, extractions, periodontics, repairs, and oral surgery
Major — crowns, inlays, dentures, and dental implants