Delta Dental PPO

As a National Association for Medical and Dental (NAFMD) member, you and your family members can enjoy the benefits of fully comprehensive dental coverage underwritten by Delta Dental. We will work with you to find the perfect plan and Dentist for your family.

Delta Dental PPO

Delta Dental PPO is an open network plan that allows enrollees to visit any licensed dentist, either in the PPO network, where you will save the most on out-of-pocket costs, the moderate cost Premier network or outside the Delta Dental network, where there are no cost protections. Enrollees who visit a network dentist receive the advantages of no billing beyond the charges allowed by the plan and the submission of claims by dentists.

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PPO Evidence of Coverage

*Age of dependent child may vary depending on state laws. Please refer to your Evidence of Coverage (EOC) for complete information about your coverage, age limits and exclusions.

Delta Dental PPO Classic and Premium Benefit Options

Dental Service Category Basic Plan Classic Plan Premium Plan
PPO Dentists†
(In-Network)
Premier and Non-Delta Dental Dentists† (Out-of-network) PPO Dentists†
(In-Network)
Premier and Non-Delta Dental Dentists† (Out-of-network) PPO Dentists†
(In-Network)
Premier and Non-Delta Dental Dentists† (Out-of-network)
Diagnostic and Preventive Services 100% 100% 100% 100% 100% 100%
Basic Services 50% 50% 80% 80% 80% 80%
Major Services Not Covered Not Covered 50% 50% 50% 50%
Orthodontic Services Not Covered Not Covered Not Covered Not Covered Child 50% Child 50%

*Pricing Varies by State

Dental Service Category Basic Plan Classic Plan Premium Plan
Annual Deductible Not Covered IN-NETWORK $50 per enrollee each contract year $150 per family each contract year OUT-OF-NETWORK $ 75 per enrollee each contract year $225 per family each contract yearIf you switch between In-Network and Out-of-Network dentists during a contract year, the deductible may be adjusted accordingly. $50 per enrollee each contract year$150 per family each Contract Year
Deductibles Waived for Not Covered Diagnostic & Preventive Diagnostic & Preventive and Orthodontic Services
Annual Maximum Not Covered $1,000 per enrollee per contract year $1,500 per enrollee per contract year
Annual Maximum waived for Not Covered Diagnostic & Preventive Services for PPO providers only Diagnostic & Preventive Services for PPO providers only
Lifetime Orthodontic Maximum Not Covered Not Covered $1,000 per dependent children to the end of the month of their 19th birthday
The maximum amount payable per contract year per dependent child for Orthodontic Services is $500. (Not to exceed the dependent child’s $1,000 lifetime Orthodontic Maximum amount.) This $500 Orthodontic benefit is inclusive of the $1,000 benefit year Annual Maximum amount.

† Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and the program allowance for Non-Delta Dental dentists.

Waiting Periods: Crowns and Inlays/Onlays and Prosthodontic Benefits are limited to enrollees who have been enrolled in the contract for 6 consecutive months. Waiting periods for dependent enrollees are determined by the primary enrollee’s length of coverage and are calculated for a primary enrollee and his/her dependent from the primary enrollee’s effective date of coverage as reported by the contract holder.

Disclaimer: This information is not intended or designed to replace or serve as an Evidence of Coverage (EOC). For complete information about your coverage, processing policies, limitations and exclusions, you should refer to the EOC.

Delta Dental of California, Delta Dental of Pennsylvania, Delta Dental of New York, Inc. and Delta Dental Insurance Company, together with affiliate companies, form one of the nation’s largest dental benefits delivery systems, covering 33 million enrollees. These companies are members or affiliates of members of the Delta Dental Plans Association, a network of 39 Delta Dental companies that together provide dental coverage to more than 68 million people in the U.S

Delta Dental PPO is underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA – Delta Dental of California; PA, MD – Delta Dental of Pennsylvania; NY – Delta Dental of New York, Inc.; DE – Delta Dental of Delaware, Inc.; WV – Delta Dental of West Virginia, Inc. In Texas, Delta Dental Insurance Company provides a Dental Provider Organization (DPO) plan. These companies are responsible for their own products. Coverage is limited to Association members residing in the listed states.

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Do You Need Dental Coverage? Give us a call if you have any questions! Taking good care of your mouth does more than help ensure you have a bright, white smile. Having a healthy mouth and healthy body go hand-in-hand! Let us help you Understand the meaning of "healthy mouth, healthy you"!


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