DHMO Dental Plan:
As a DeltaCare USA DHMO member, 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.
DHMO Plan Highlights:
- Teeth cleanings are covered once per 6 month period.
- No co-payments are required for most services, although there are some procedures and optional services that may include additional charges.
- The orthodontic benefit covers up to 24 months of active orthodontic treatment (additional start-up fees apply). Beyond 24 months of active treatment, an additional monthly fee will apply.
PPO Dental Plan:
The Delta Dental PPO (SISC) plan is a preferred provider dental plan. The benefits cover a wide range of dental services. You may visit a PPO dentist and benefit from the negotiated rate or visit a non‐network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be less. You may also obtain services using a non-network dentist; however, you will be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims.
PPO Plan Highlights:
- Teeth cleanings are covered twice per year.
- As a PPO member, you may use a PPO dentist outside of the PPO plan network, but you will pay more out-of-pocket and may be responsible for filing claims. Reimbursement for the PPO plan is based on Delta Dental’s schedule of maximum allowable charges. Non-contracted dentists may bill the member for any amount above Delta Dental’s maximum allowable charges. If you are balance billed by a dentist, you may be able to negotiate a lower payment directly with the dental office.
- Delta Dental pays 70% of the approved fees for covered diagnostic, preventive and basic services and 70% of the approved amount for 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 enrollee provided that person visits the dentist at least once during the year. If an enrollee does not use the plan during the calendar year, the percentage remains at the level attained the previous year. If an enrollee becomes ineligible for benefits and later regains eligibility, the percentage will drop back to 70%.