Delta Dental Ppo Florida

Delta Dental Ppo Florida – Freedom of choice – the patient can visit any dentist. Reduced Fee for Service: Maximize Savings Using PPO Dentists Nationwide Coverage – Visit any licensed dentist in the world Visiting a Delta Dental PPOSM dentist typically saves patients an average of 30% of their out-of-pocket costs

Benefits and Covered Services Delta Dental PPO Dentists Delta Dental Premier Dentists Non-Delta Dentists WHO ELIGIBLE Primary enrollee, eligible spouse and dependent children DEDUCTIBLE $75 per individual, $225 per family, per plan year DEDUCTIBLE LIMITED TO DIAGNOSTICITY? Yes ANNUAL MAXIMUM **D&P count towards maximum? Maximum benefit paid per plan year is $1,500 per person NO **New benefit in 2019 DIAGNOSTIC & PREVENTIVE BENEFITS — Oral exams, cleanings, x-rays, fluoride treatment, janitorial, sealants 100%* (3 times per plan year) (3 times per plan year) BASIC BENEFITS — Fillings, prosthetic repairs, endodontics (root canals), periodontics (gum treatment), maxillofacial surgery 80%* MAIN BENEFITS — Crowns, veneers and plaster and prosthetic restorations (bridges, partial dentures, full prostheses), implants 50%* 50% * DENTAL PROCEDURE (adults and children) DENTAL PROCEDURE MAXIMUM USD 1,500 INITIATED PROCEDURES REFUND BASED ON CONTRACT Delta Dental Allowable amounts *from Delta Dental above the allowed amounts are not intended for the amount. as a comprehensive description of the plan. See your benefits booklet for full details, including limitations and exclusions.

Delta Dental Ppo Florida

Call Delta Dental at (800), seven days a week. Choose from automated voice recordings, automated fax, or live operators for information from 7:00 a.m. to 7:00 p.m. (central time). Visit us on our website at deltadentalins.com/tamus to: Find a dentist with IELP features and directions on a map Check eligibility and benefits View claim information Recommend your dentist Print an ID and application form Read dental health tips and articles Visit SmileKids, a fun way for children to learn about oral health

Delta Dental’s Networks: What’s The Difference?

The patient pays a predetermined co-payment for each covered procedure. The patient chooses or is assigned a dentist upon enrollment. Special care provided by specialists requires prior approval. Special care is usually treated as a request.

Enrollees must use their designated dentist to receive benefits. No deductible or annual maximums. No (or very low) co-payments for diagnostic and preventive services. Fixed fees for basic and main services.

DeltaCare® USA Plan 15B ELIGIBLE Primary Enrollment, Eligible Spouse and Dependent Children DEBED No MAXIMUM DIAGNOSTIC AND PREVENTIVE BENEFITS* Comprehensive Oral Exam: $0 Cleanings (every six months): $5 Panoramic X-rays every three years : (0 once). every 3 years BENEFITS* Amalgam fillings – single surface: $8 resin-based composite filling; two surfaces, rear; permanent: $75 Anterior root canal, excluding final restoration: $125 Periodontal scaling and root planing; per quadrant, limited to 4 quadrants in 12 consecutive months: $60 BIG DEAL* Crown; porcelain/ceramic base: $395 Complete denture; maxillary: $365 DENTAL PLAN* Orthodontic treatment plan and records: $200 Comprehensive treatment; permanent teeth (children up to age 19; higher deductible for adults): $1,900 ORTHODONIC TERMINATIONS Available in Texas, California, District of Columbia, Florida, Georgia, Maryland, Nevada, New York, Pennsylvania, Utah and West Virginia to cover where already covered desio * The above payments are only representative samples and are not intended to apply to every procedure. For a complete payment schedule, including plan limits and exclusions, see your plan booklet.

DeltaCare® USA provides continued orthodontic coverage that allows enrollees to enjoy the same coverage and benefits as their previous program. The provision is available to first-time registrants where connection has already taken place. To register for this position, go to the Texas A&M System HR website at to obtain the form and follow the instructions on how to apply

Medicare Dental Insurance Coverage

The toll-free number – (800) is available seven days a week. Choose from automated voice recordings, automated fax, or live operators for information from 7:00 a.m. to 8:00 p.m. (central time). Visit our website at deltadentalins.com/tamus to: Find a dentist with IELP features and directions on a map Check eligibility and benefits View claim information Refer to your dentist Print an ID card Read dental health tips and articles Visit SmileKids, a fun way for kids to learn about oral health • *** Remember you can also check the Texas A&M System Benefits website: tamus.edu/offices/benefits/programs/#dental for an additional list of dentists exclusive to the Texas A&M System Dental HMO Plan * **

The Texas A & M System PPO plan is administered by Delta Dental Insurance Company. DeltaCare USA is sponsored by Delta Dental’s subsidiary Alpha Dental Programs, Inc. and administered by Delta Dental Insurance Company.

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