Delta Dental PPO 1500 + VSP Vision
Delta Dental PPO + VSP Choice
Delta Dental PPO 1500 + VSP Vision bundle — Dental: $1,500 annual max, $50/$150 deductible, 100%/80%/50% in-network, carryover max. Vision (VSP Choice): $10 exam / $25 materials copay, $150 frame allowance every 24 months, $150 contact allowance, lenses every 12 months.
Monthly premiums
- Member
- $77.50/mo
- Member & Children
- $131.50/mo
- Member & Spouse
- $140.00/mo
- Member & Family
- $206.50/mo
Benefits
Dental Annual Maximum
$1,500 per person
Delta Dental PPO 1500
Dental 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)
Carryover Max
Included
Roll unused annual maximum forward
Eye Exam
$10 copay
VSP Choice network • every 12 months
Frames
$150 allowance
+ 20% off overage • every 24 months
Lenses
$25 copay
Single, bifocal, trifocal, lenticular • every 12 months
Contact Lenses
$150 allowance
+ 15% off fitting • medically necessary covered in full
Waiting Periods
None
Full coverage from effective date
Plan documents
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