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.
NJCC dental plans
 |
NJCC dental plans - plan comparison |
| Service | Delta Dental PPO™ Low Plan | Delta Dental PPO™ Mid Plan | Delta Dental PPO Plus Premier™ High Plan | Flagship Voluntary NJ7 |
|---|---|---|---|---|
| P&D only plan | 100/50/50 plan design | 100/80/50 plan design | Member pays the amounts listed below | |
| Calendar year maximum (per person) | $500 | $1,000 | $1,500 | N/A |
| Calendar year deductible (waived on Preventive & Diagnostic) | ||||
| Per person | $0 | $50 | $50 | $0 |
| Family aggregate | $0 | $150 | $150 | $0 |
| Waiting period | None | None | None | None |
| Preventive & diagnostic | ||||
| Oral Exams and evaluations (consultations - combined with all other exams; emergency exams - combined with all other exams) | 100% | 100% | 100% | No cost |
| Cleanings/Prophylaxis (2 per calendar year) |
100% | 100% | 100% | No cost |
| Bitewing x‐rays (twice per calendar year for persons 18 and younger, once per calendar year for persons age 19 and over) | 100% | 100% | 100% | No cost |
| Full mouth X-rays or panoramic film (1 per 5 years) | 100% | 100% | 100% | No cost |
| Sealants (1 per lifetime per tooth (dependents through age 14) on permanent molars with no prior restorations on the “O” surface. Not covered in addition to resin fillings) | 100% | 100% | 100% | $30 per tooth |
| Topical flouride (2 per calendar year, to age 18) | 100% | 100% | 100% | No cost |
| Space maintainers (1 per arch, per lifetime, to age 13) | 100% | 100% | 100% | No cost |
| Basic services | ||||
| Fillings (Repeat restorations of same surface payable once in 2 years) | Not covered | 50% | 80% | No cost |
| Composite/resin restorations on second bicuspids and molars (including composite restorations on all teeth) | Not covered | 50% | 80% | No cost |
| Simple extractions (1 per lifetime per tooth) | Not covered | 50% | 80% | N/A |
| Root canal therapy (Endodontics) | Not covered | 50% | 80% | $185 - $285 |
| Periodontal maintenance (2 per calendar year. Periodontal maintenance is interchangeable with, but not in addition to, routine cleanings) | Not covered | 50% | 80% | $50 |
| Scaling and root planing (1 per 2 years per quadrant) | Not covered | 50% | 80% | $70 |
| Periodontal surgeries (gingivectomy, osseous surgery, flap surgery and grafts, etc. -1 per 3 years per quadrant. Note, frequencies vary by procedure code) | Not covered | 50% | 80% | $80 - $275 |
| Oral surgery (Frequencies vary by procedure code. If performed within 6 months of a major restoration or endodontic procedure no further benefits provided for the extraction.) | Not covered | 50% | 80% | No cost |
| General anesthesia or IV sedation (payable with covered oral surgery) | Not covered | 50% | 80% | No cost |
| Major services | ||||
| Single crowns (Replacement 1 in 5 years against itself or any other major services on the same tooth.) | Not covered | 50% | 50% | $100 - $290 |
| Stainless steel crowns (Replacement 1 in 2 years) | Not covered | 50% | 50% | $75 |
| Crown inlay, onlay, and veneer repairs (No frequency limitations) | Not covered | 50% | 50% | $270 |
| Crown recements (Replacement 1 in 5 years) | Not covered | 50% | 50% | No cost |
| Post and core (Payable 6 months after insertion then 1 in 12 months) | Not covered | 50% | 50% | $200 - $275 |
| Inlays (Given alternate benefit of a composite filling) | Not covered | 50% | 50% | No cost |
| Inlays/Onlays (If inlays are payable replacement 1 in 5 years; onlays are payable 1 in 5 years) | Not covered | 50% | 50% | $279 |
| Implants (Once every 60 months per tooth for ages 16 and older) | Not covered | 50% | 50% | N/A |
| Bridgework (abutment crowns and pontics; 1 per 5 years) | Not covered | 50% | 50% | $290 |
| Bridgework - recements (Not billable when performed within 6 months of initial placement by the same dentist/dental office, but then payable 1 per 12 months) | Not covered | 50% | 50% | No cost |
| Bridgework - repairs (Not billable within 12 months of the initial placement, but then payable 2 per 3 years) | Not covered | 50% | 50% | No cost |
| Full and partial dentures (1 placement per 5 years) | Not covered | 50% | 50% | $300 - $340 |
| Dentures - adjustments (Not billable when performed within 6 months of the initial placement by the same dentist/dental office, but then payable 2 in 12 months) | Not covered | 50% | 50% | No cost |
| Dentures - repairs, retines, rebases (Not billable when performed within 6 months of the initial placement by the same dentist/dental office, but then payable 1 in 6 months) | Not covered | 50% | 50% | $50 - $60 |
| Orthodontics | Children to age 26 | Adults & Children | ||
| Full comprehensive treatment | Not covered | Not covered | 50% | Covered |
| Lifetime Maximum | N/A | N/A | $1,500 | N/A |
| Out-of-Pocket Maximum | N/A | N/A | N/A | $2,900 |
Your dentist's network will impact how much you pay. Dentists that help participate in the Delta Dental PPO will have the lowest costs and will save you the most out-of-pocket expense. Dentists that participate in Delta Dental Premier, are participating Delta Dental dentists, but you will pay a greater portion of the cost if utilized. If you receive services from a non-participating, out-of-network dentists, you will pay the most out-of-pocket and are responsible for your coinsurance amount plus the difference between Delta Dental's approved fee and the dentist submitted fee for the claim.
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.
