Dental
Taking care of your oral health is not a luxury; it is a necessity for long-term optimal health. With a focus on prevention, early diagnosis, and treatment, Dental insurance can greatly reduce your costs when it comes to restorative and emergency procedures.
When you visit a dentist in the network, you will maximize your savings. These dentists have agreed to reduced fees, which means you won’t get charged more than your expected share of the bill.
Delta Dental PPO (California & Non-California)
Plan Information
Plan Name: Delta Dental PPO
Policy Number: 17403
Effective Date: 01/01/2025
Network: Delta Dental
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$50/$150
Annual Plan Maximum
$1,500 per person
Preventive Care
$0
Basic Services
20% coinsurance
Major Procedures
50% coinsurance)
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,000 per individual; deductible waived
Out-of-Network
Deductible (Individual/Family)
$50/$150
Annual Plan Maximum
$1,500 per person
Preventive Care
$0
Basic Services
20% coinsurance
Major Procedures
50% coinsurance
Orthodontia (Adults and Children)
50% up to a lifetime maximum benefit of $2,000 per individual; deductible waived
Carrier Flyers
Delta Dental Dual Coverage Flyer
Delta Dental Elevate Your Smile Flyer PPO
Delta Dental Declination of Dental Coverage Form
Delta Dental How to Print an ID Card
Delta Dental Spanish Enrollment Form
Delta Dental Dentalcare Plan Summary
Delta Dental Savings You Can See and Hear
Plan Documents
Contact Information
Delta Dental HMO (CA Only)
Plan Information
Plan Name: DeltaCare USA DHMO
Policy Number: 77009
Effective Date: 01/01/2025
Network: Delta Dental
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Annual Plan Maximum
Unlimited
Preventive Care
$0
Basic Services
$0-$300 (varies by services; see contract for fee schedule)
Major Procedures
$240-$295 (varies by services; see contract for fee schedule)
Orthodontia (Adults and Children)
Adults $1,900
Children $1,700
Carrier Flyers
Delta Dental Dual Coverage Flyer
Delta Dental Elevate Your Smile Flyer HMO
Delta Dental Declination of Dental Coverage Form
Delta Dental How to Print an ID Card
Delta Dental Spanish Enrollment Form
Delta Dental Dentalcare Plan Summary
Delta Dental Savings You Can See and Hear