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expenses will be less, however, 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 be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing
FINDING A DENTAL PROVIDER Go to www.deltadentalins.com. PPO members refer to the Delta Dental PPO or Delta Dental Premier network when prompted. Dental Plan choices
This plan offers you the freedom and flexibility to use the dentist of your choice. However, you will maximize your benefits and reduce your out-of-pocket
costs if you choose a dentist who participates in the Delta Dental PPO or Premier network. When you utilize a PPO or Premier dentist, your out-of-pocket
Dental Plan Choices
NON-NETWORK 80% 80% 50%
DELTA DENTAL PPO DELTA DENTAL PREMIER $50 / $150 $1,500 80% 80% 50% 50% $1,500
claims. The chart below provides a high-level overview of your dental plan.
DELTA DENTAL PPO Benefit Maximum (per calendar year; Preventive, Basic and Major Services 100% Deductible Waived 80% 50%
Deductible (per calendar year)
DPPO Plan PLAN NAME NETWORK NAME Individual / Family combined) Per Individual Covered Services Preventive Services Basic Services Major Services Orthodontia (Child/Adult)