DeltaCare DHMO Plan
With the Dental Health Maintenance Organization (DHMO) plan through Delta Dental, you are required to select a general dentist to provide your dental care. You will contact your general dentist for all of your dental needs, such as routine check‐ups and emergency situations. If specialty care is needed, your general dentist will provide the necessary referral. In addition to orthodontia coverage, the DHMO dental plan highlights include:
- There is no plan deductible.
- Services are only covered when you use DHMO network providers.
- You must select a general dentist from the DHMO plan’s pre-approved list of dental providers. Each family member may choose his or her own dentist.
- There is no annual maximum benefit.
- For covered procedures, you’ll pay the pre‐set copay or coinsurance fee described in your DHMO plan schedule. Please keep a copy of your schedule to refer to when utilizing your dental care. This will show the applicable copays that apply to all of the dental services that are covered under this plan.
- Your dentist will file all claims on your behalf.
Delta Dental PPO Plan
With the Delta Dental Preferred Provider Organization (PPO) plan, you may visit a PPO dentist, a Premier dentist, or a non-network dentist. When you access services from a PPO or Premier dentist, your out-of-pocket expenses will be less. You will usually pay the lowest amount for services when you visit a Delta Dental PPO dentist. If you obtain services using a non-network dentist, you will incur higher out-of-pocket expenses and you may be responsible for filing claims. This plan does not include orthodontia coverage. PPO dental plan highlights include:
- This plan includes a deductible for individual and family coverage.
- You may receive services from providers inside and outside the PPO network.
- You are not required to select a general dentist.
- Each family member is subject to an annual maximum benefit.
- Most services are covered on a coinsurance basis.
- Most PPO dentists will file claims on your behalf. However, if you use the non-network tier of the plan, you may have to pay the dentist in full and then file a claim for reimbursement.
- Out-of-pocket costs will be higher if you use non-network dentists.
Dental PPO Plan Incentive
The PPO plan will pay 70% of the approved fees for covered diagnostic, preventive and basic services, as well as cast and crown benefits during the first year of eligibility. The copay percentage will increase by 10% each year (to a maximum of 100%) for each member who visits the dentist at least once during the year. If a member does not use the plan during the calendar year, the percentage remains at the level attained the previous year.
Download the Delta Dental app on the App Store or Google Play to access your Delta Dental Plan information 24/7 from your mobile device. The Delta Dental app allows you to view your benefits and claims, find a dentist, estimate dental expenses and access your dental ID card. The app also features a Toothbrush Timer to support you with healthy dental self-care.