Retiree - Delta Dental Basic
Delta Dental Basic offers choice and flexibility through a large network consisting of both the Delta Dental PPO in-network and the Delta Dental Premier in and out-of-network dentists.
Delta Dental PPO in-network providers offer services at a lower negotiated fee schedule, resulting in lower member copays. There is also no balance billing when utilizing a PPO dentist.
Delta Dental Premier in-network or out-of-network dentists are paid at a higher negotiated fee schedule. With Premier network dentists, there will never be balance billing.
Go to www.deltadentalky.com to locate a provider.
In all cases, plan members are responsible for coinsurance, deductibles, and non-covered services.
Delta Dental Basic Plan Features
- Diagnostic and preventive care to maintain good oral health.
- 20% coinsurance after $25 deductible on minor restorative services.
- Coverage for preventive and minor restorative procedures only.
Delta Dental Basic Summary of Benefits
Choosing a Dentist |
Based on Delta Dental PPO & Premier in-network |
Annual Deductible |
$25/person; $75/family |
Covered Benefit: Routine Office Visit |
100% |
Preventive: |
100% |
Restorative Services: Restorative filings |
80% |
| Simple extractions | 80% |
| Periodontic services | 80% |
| Crown or bridge | Not covered |
| Endodontics (root canal) | 80% |
| Oral Surgery | 80% |
| Complete/partial dentures | Not covered |
| Orthodontics | Not covered |
