Notice
Change Healthcare announced a breach of HIPAA privacy and is reaching out to individuals whose personal information may have been compromised. Although this incident does not involve Delta Dental of New Jersey or Connecticut, Change Healthcare is a vendor we used and we are providing this information to help our members who might be affected.
Delta Dental PPO Plus Premier™ Plan
Delta Dental PPO Plus Premier™ Plan - Group #09317
Your dentist’s network will impact how much you pay.
PPO Network
Using a PPO provider is considered in network and will offer you the greatest savings on dental services which will spread your annual maximum further.
Premier Network
Using a Premier provider is considered in network but will not offer as robust savings as the PPO network. It is the largest network.
Out of Network
You have the freedom to choose any dentist that does not participate in either of the above networks. Claims will be reimbursed at the 90th UCR level but there may be balance billing and your maximum will not go as far.
| Service | Delta Dental PPO Plus PremierTM |
|
|---|---|---|
| In Network If a Delta Dental PPOTM Dentist is Used |
Out-of-Network If a Delta Dental Premier* or Non-participating Dentist is Used |
|
Preventive & Diagnostic (does not count towards calendar year maximum)
|
100% | 100%* |
Basic
|
90% | 80% |
Major
|
60% | 50% |
| Calendar Year Maximum (per person) | $2,000 | $2,000 |
| Calendar Year Deductible Per person Family Aggregate Deductible Waived for |
$50 $150 Preventive & Diagnostic |
$50 $150 Preventive & Diagnostic |
| Orthodontics Adult & Child Lifetime Maximum |
100% $2,000 |
100% $2,000 |
Delta Dental of New Jersey is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
