Bean Automotive • 2024-2025 Benefits Guide
DENTAL DELTA DENTAL
To find a network provider, call Delta Dental at 800.521.2651 (DPPO) or 800.422.4234 (DHMO) or visit deltadentalins.com. Select “Delta Dental PPO” or “Delta Dental Premier” for the DPPO and select “DeltaCare USA” for the DHMO.
Although you can choose any dental provider, when you use an in-network dentist, you will generally pay less. If you choose an out-of-network provider, you may be billed the difference between what Delta Dental pays, and what your out-of-network provider charges for the services.
Delta Dental DPPO
Network: Delta Dental PPO/Premier Annual Deductible (Individual/Family)
In-Network
Out-of-Network
$50/$150
$50/$150
Annual Maximum (per person)
$5,000
$2,500
Diagnostic and Preventive Care Includes oral exams, cleanings, fluoride treatments, sealants and x-rays
100%
100%
Basic Services Includes fillings, simple extractions and general anesthesia
80% after ded
70% after ded
Major Services Includes crowns, bridges, dentures, oral surgery, endodontics, periodontics and implants
50% after ded
40% after ded
Orthodontia (Children and Adults) Orthodontia Lifetime Maximum
50%
50%
$1,000
$1,000
Delta Dental DHMO
Network: DeltaCare USA
In-Network Only
Office Visit
$0-$35
Preventive and Diagnostic Dentistry Includes x-rays, cleanings, and sealants Restorative Dentistry Includes fillings. inlays, onlays and crowns Endodontics Includes anterior and molar root canals
$0-$70
$0-$380
$0-$380
Periodontics Includes osseous surgery, scaling and root planning
$0-$345
Oral Surgery Includes simple and surgical extractions
$0-$130
Orthodontia Children and Adults
$1,150-$2,100
The member is ultimately responsible for verifications of the accuracy and appropriateness of all fees applicable to any dental benefit provided by a network provider. We urge members to verify all fees for proposed treatment via Schedule of Benefits and/or with the Member Services Department prior to treatment.
17
Made with FlippingBook - Online Brochure Maker