Delta Dental for Individuals and Families

STEP 1: Review Plan Benefits

Plan Comparison - Select A Plan

Plan Options	Option 1 Patient Direct®	Option 2 PPO Direct Plan	Option 3 PPO Plus Direct Plan
Plan Type:	DISCOUNT PLAN (not insurance)	INSURANCE PLANS
Dentist Network:	Delta Dental Patient Direct® 1	Delta Dental PPO 2	Delta Dental PPO	Delta Dental Premier® or Non-Participating
Colorado Network Size: (includes general dentists and specialists)	400	1130	1130	2500
Out of Network Services:	No	No	Yes
Benefit Year Maximum:	No Maximums	$1,000	$1,500
Benefit Year Deductible/Family:	No Deductibles	$75 per person	$50 per person
Deductible applies to:		Basic and Major	Basic and Major
COVERED SERVICES
Type I-Diagnostic & Preventive	No Waiting Period	No Waiting Period	No Waiting Period
Exams oral (1 in 6 months) Cleanings (1 in 6 months) Fluoride Treatments (1 in 12 months, under age 16) Space Maintainers (under age 14) Sealants (under age 15) All X-rays	Savings range from 50% to 100% 3	Covered at 100%	Covered at 100%	Covered at 90% 4
Type II-Basic Services	No Waiting Period	No Waiting Period	No Waiting Period
Simple Extractions Fillings	Savings range from 50% to 80% 3	Covered at 70%	Covered at 80%	Covered at 70% 4
Type IIIA-Major Services	No Waiting Period	12-month waiting period	12-month waiting period
		Credit will be given with proof of prior dental coverage6
Surgical Extractions General Anesthesia  (with oral surgery only) Endodontics (Root Canal Therapy) Periodontics (gum treatment) Denture relines and rebases, adjustments Repairs to crowns, dentures, and bridges	Savings range from 50% to 67% 3	Covered at 40%	Covered at 60%	Covered at 50% 4
Type IIIB-Major Services	No Waiting Period	24-month waiting period	24-month waiting period
		Credit will be given with proof of prior dental coverage 6
Special Restorative Crowns Complete and Partial Dentures Fixed Bridgework	Savings range from 50% to 67% 3	Covered at 40%	Covered at 60%	Covered at 50% 4
Orthodontics	No Waiting Period	Not a Benefit 5	Not a Benefit 5
Adult & child	Savings range from 21% to 23% 3
Monthly Rates
Individual Only Individual and One Dependent Individual and Two or More Dependents	$14.25 $25.25 $36.25	$28.00 $52.00 $72.00	$36.00 $67.00 $93.00
	Select Option 1	Select Option 2	Select Option 3

¹ Member and family must select one general dentist; all general services must be obtained from the selected dentist to receive discounts. Specialty services are available from any Patient Direct participating specialist without a referral.

² Member must receive all dental care from a PPO Dentist in order for services to be considered for coverage.

³ Savings shown are an approximation and could be higher or lower depending on where the network dentist is located in Colorado and if they are a General Dentist or a Specialist.

⁴ If the member does not use a PPO dentist, and the dentist charges more than the PPO Dentist’s allowable fee, the member will be responsible for any excess. If the member sees a Premier Dentist, the member is responsible for the difference between the PPO Dentist’s Allowable Fee and the fee from the Premier Maximum Plan Allowance. If the member sees a non-participating dentist, the member is responsible for the difference between the PPO Dentist’s Allowable Fee and the billed charges.

⁵ Orthodontic services are not covered. The orthodontic fee will be based on the PPO Dentist's Allowable fee for PPO dentists, or on the Maximum Plan Allowance for Premier dentists.

⁶ If you’ve been enrolled in a dental plan within 90 days of your effective date in this plan,  you will receive reduced waiting periods based on the amount of time you had coverage.  For consideration, just submit your certificate of prior dental coverage to us before your effective date.  Details will be provided in your email confirmation notice once you complete the enrollment process.

NOTE:   To join any of these plans, you cannot have other dental coverage.