You have a choice of two dental plan options: Delta PPO and DeltaCare DHMO through Delta Dental of Illinois. Both include a variety of benefits and coverages including preventive services covered in full when received from network providers.
The PPO option features a wide network of dental providers and offers coverage for in- and out-of-network services. You do not need to select a primary dental provider, however your out-of-pocket costs will be lower if you receive care from a dentist in the Delta PPO or Delta Premier networks.
Under the DeltaCare DHMO option you must receive services from a dentist in the DeltaCare network and you must select a primary dentist for you and your covered dependents. You pay only the patient copayment for covered procedures, and there are no deductibles, annual benefit maximums or claim forms to complete. If you choose this option, you will be prompted to enter a dental provider ID for each family member.
Here’s how to make the most of your dental benefits if you are enrolled in the PPO:
Each time you need dental care, you have a choice of providers. Selecting a Delta Dental of Illinois participating dentist will ensure you receive the highest benefits from your plan. To find an in-network provider near you, visit Delta Dental of Illinois or call 800.323.1743.
Give your provider’s office the information they need to bill your insurance.
You should submit a request for a pre-treatment estimate for procedures and services your dentist believes will exceed $100 (procedures such as crowns, inlays, bridges, and periodontics). For more information, visit Delta Dental of Illinois or call 800.323.1743.
You can review Explanation of Benefits (EOB) statements, check if claims have been paid, and more.
You may choose to see any in- or out-of-network dentist you’d like under the PPO, but you’ll generally pay less when you stay in network. To find an in-network provider near you, visit Delta Dental of Illinois or call 800.323.1743.
| Dental Plan Highlights | Delta PPO | DeltaCare DHMO | ||
|---|---|---|---|---|
| Delta Dental Network | PPO | Premier | Out-of-Network | In-Network |
| Individual | $0 | $50 | $50 | $0 |
| Family | $0 | $150 | $150 | $0 |
| Deductible Applies to | N/A | Basic and Major | Basic and Major | N/A |
| Annual Maximum | $2,000 | Unlimited | ||
| Preventive Services | 100% | 100% of MPA* | 90% of MPA* | 100% |
| Basic Services | 80% | 80% of MPA* | 70% of MPA* | Covered according to fee schedule |
| Major Services | 50% | 50% of MPA* | 50% of MPA* |
Covered according to fee schedule
No coverage for dental implants
|
| Periodontics | 80% | 80% of MPA* | 70% of MPA* | Covered according to fee schedule |
| Endodontics | 80% | 80% of MPA* | 70% of MPA* | Covered according to fee schedule |
| Orthodontics | Covered at 50% up to a lifetime maximum of $2,000 | Covered subject to copay Must use DHMO network orthodontist |
||
*MPA = Maximum Plan Allowance. You are not responsible for charges exceeding MPA for services performed by a Delta Premier dentist. Out-of-Network providers may charge you for costs exceeding MPA.
Review your 2024 Delta Dental of Illinois plan coverage.
| Dental Plan Premiums (26 Times Per Year) | Employee Only | Employee + Child(ren) | Employee + Spouse | Employee + Family | Employee Only | Employee + Child(ren) | Employee + Spouse | Employee + Family |
|---|---|---|---|---|---|---|---|---|
| Full-Time Employees | Part-Time Employees | |||||||
| Delta PPO | $11.43 | $32.32 | $22.85 | $43.75 | $13.69 | $38.78 | $27.40 | $52.51 |
| DeltaCare DHMO | $5.02 | $10.47 | $9.28 | $14.73 | $6.02 | $12.56 | $11.13 | $17.69 |
