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Delta Dental PPO 1500

Delta Dental

Delta Dental PPO 1500 — Annual Maximum: $1,500 per person; Deductible: $50 / $150; Preventive & Diagnostic: 100% covered; Basic Services: 80% covered; Major Services: 50% covered.

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Monthly premiums

Member: $61.50/mo
Member & Children: $109.50/mo
Member & Spouse: $117.00/mo
Member & Family: $174.00/mo

Benefits

Annual Maximum
$1,500 per person
Deductible
$50 / $150
Individual / Family (in-network)
Preventive & Diagnostic
100% covered
Cleanings, exams, X-rays (in-network)
Basic Services
80% covered
Fillings, extractions, root canals (in-network)
Major Services
50% covered
Crowns, bridges, dentures, implants (in-network)
Waiting Periods
None
Full coverage from effective date
Carryover Max
Included
Roll unused annual maximum forward
Network
Delta Dental PPO
3 of 4 dentists nationwide
Out-of-Network
Covered
80% preventive / 50% basic; $100 / $300 deductible

Plan documents

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