Delta PPO (2008)
Delta PPO is an indemnity dental plan. This is Delta's most comprehensive dentist network, with about 3 out of 4 U.S. dentists participating. Patients have the option to use any dentist anywhere in the world. If you visit a Delta Dentist, you'll enjoy the advantage of pre-negotiated fees and convenient claims handling.
There is a $50 per person calendar year deductible, family maximum $150. Calendar year maximum benefit is $1,000 per person; Diagnostic and Preventive procedures are not applied towards the maximum benefit of $1,000 per person.
| Preventative & Diagnostic (not subject to deductibles) | |||||||||
| Oral Exams | #+80% | ||||||||
| X-rays | #+80% | ||||||||
| Prophylaxis (teeth cleaning 2 per calendar year) | #+80% | ||||||||
| # Diagnostic & Preventive procedures are not subject to the calendar year maximum. | |||||||||
| + Benefits paid at 100% if services are provided by a Delta PPO Dentist. | |||||||||
| Restorative | |||||||||
| Amalgam one surface, permanent (filling) | 80% | ||||||||
| Tooth colored resin filling | 80% | ||||||||
| Crown-porcelain/ceramic | 50% | ||||||||
| Prosthetics* | |||||||||
| Denture-complete upper or lower* | 50% | ||||||||
| Bridge-porcelain fused metal, per-unit* | 50% | ||||||||
| * Waiting Period: 12 months of continuous coverage | |||||||||
| Endodontics - Root Canal Therapy | |||||||||
| One Canal | 80% | ||||||||
| Two Canals | 80% | ||||||||
| Apicoectomy | 80% | ||||||||
| Periodontics | |||||||||
| Subgingival Curettage | 80% | ||||||||
| Gingivectomy or Gingivoplasty | 80% | ||||||||
| Orthodontics | |||||||||
| Co-payment | 50% | ||||||||
| Lifetime Maximum | $1,000.00 | ||||||||
| Monthly Rates through 12/2008 (Includes $1.00 administration fee) |
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