Novartis Benefits Overview
PPO Network
Using a PPO dentist is considered in-network and will offer you the greatest savings on dental services and will maximize your benefits.
Premier Network
Using a Premier dentist is considered in-network and will offer you great savings on dental services. It is the largest network.
Out of Network
You have the freedom to choose any dentist that does not participate in either the PPO or Premier networks.
| In-Network | Out-of-network | |
|---|---|---|
| Service | If a Delta Dental PPO or a Delta Dental Premier Network Dentist is used | If a Non-participating Dentist is Used |
| Annual maximum (per person) | $2,000 | $2,000 |
| Annual deductible (waived for Preventive & Diagnostic) | ||
| Per person | $50 | $100 |
| Family aggregate | $150 | $300 |
| Preventive & Diagnostic | ||
| Exams (Frequency limitations apply) | 100% | 100% |
| Cleanings (Frequency limitations apply) | 100% | 100% |
| Bitewing X-Rays | 100% | 100% |
| Fluoride Treatment (Frequency and age limitations apply) | 100% | 100% |
| Sealants, Space Maintainers | 100% | 100% |
| Basic Services | ||
| Fillings (composite fillings on all teeth) | 80% | 80% |
| Simple Extractions | 80% | 80% |
| Root Canals (Endodontics) | 80% | 80% |
| Periodontal Maintenance | 80% | 80% |
| Periodontics (Surgical), Oral Surgery | 80% | 80% |
| Repair of dentures | 80% | 80% |
| Major Services | ||
| Crowns & Gold Restorations | 60% | 50% |
| Bridgework, Full & Partial Dentures | 60% | 50% |
| Implants | 60% | 50% |
| Orthodontics (Adult and Child) | ||
| Co-insurance | 50% | 50% |
| Lifetime maximum | $2,000 | $2,000 |
| TMJ (Temporomandibular Joint) | ||
| Co-insurance | 50% | 50% |
| Lifetime maximum | $1,500 | $1,500 |
* Effective January 1, 2025, the Novartis Dental plan will now be administered by Delta Dental. Any reimbursements you received from the Novartis plan for TMJ and Orthodontic benefits will be transferred to Delta Dental since this is a lifetime benefit.
* If you were on the MetLife dental plan then your lifetime maximum history will rollover to your new Delta Dental for both orthodontics and TMJ.
Illustrative out-of-pocket fee for getting a crown
| Dentist's charge | Sample Delta Dental fees | Member Co-insurance | Delta Dental Pays | Balance billed amount | Amount you pay out of pocket | |
|---|---|---|---|---|---|---|
| PPO Network | $1,714 | $790 | 40% | $474 | $0 | $316 ($790 - $474) |
| Premier Network | $1,714 | $930 | 40% | $558 | $0 | $372 ($930 - $558) |
Above illustrative fee is based on a New Jersey zip code – fees will vary by location.
