Maximum
Deductible
Office visit copay
Waiting periods
How you pay
Preventive
Cleanings
Fillings
Basic
Major
Implants
Orthodontics
Dentist network
Contract
Monthly
Max 5000 Plan
$5,000 maximum
$200 per person deductible
None
Waiting periods may apply
—
Plan pays 100% for Preventive
—
70% for Fillings
—
40% for Major
—
Not a covered benefit
PPO, Premier.
You may see any dentist; however, your out-of-pocket expenses will likely be less if you see a Delta Dental network dentist
*Requires annual contract
Approx $83.00/month
Individual
Premium Plan
$2,000 maximum per person
$100 per person deductible,
once per lifetime for as long as the policy is in force
None
Waiting periods may apply
—
Plan pays 100% for Preventive
—
80% for Fillings
—
50% for Major
—
This policy doesn't include an orthodontic benefit
PPO, Premier.
You may see any dentist; however, your out-of-pocket expenses will likely be less if you see a Delta Dental network dentist
*Requires annual contract
Approx $90.50/month
Individual
Clear Plan
No annual maximums
No annual deductibles
None
No waiting periods
You pay fixed dollar amounts for services
—
$60 copay for Cleanings
$90 for Fillings
—
—
$2,500 for Implants
This policy doesn't include an orthodontic benefit
PPO, Premier.
Benefits are paid only when members see a Delta Dental PPO or a Delta Dental Premier dentist
*Requires annual contract
18-25 yrs old: $38.75/mo
26-50 yrs old: $43.75/mo
51+ yrs: $62/mo
Enhanced Plan
$1,000 maximum per person
$50 per person deductible
None
Waiting periods on some services
—
Plan pays 100% for Preventive
—
50% for Fillings
—
50% for Major
—
This policy doesn't include an orthodontic benefit
PPO, Premier.
You may see any dentist; however, your out-of-pocket expenses will likely be less if you see a Delta Dental network dentist
*Requires annual contract
Approx $57.25/month
Individual
Progressive Plan
Increasing max benefits through first 3 years enrollment
Year 1: $1,500, Year 2: $1,750, Year 3: $2,000
$50 per person deductible
None
No waiting periods
—
Plan pays 100% for Preventive
—
—
—
—
—
This policy doesn't include an orthodontic benefit
Delta Dental PPO.
You may see any dentist; however, your out-of-pocket expenses will likely be less if you see a Delta Dental network dentist
*Requires annual contract
Approx $69.75/month
Individual
Basic Plan
$1,000 maximum per person
$0 deductible
$15 per person, per visit
Waiting periods on some services
—
Plan covers 50% - 100% for Preventive
—
50% for Fillings
50% for Basic
Root canal not covered
Doesn't cover Major
—
This policy doesn't include an orthodontic benefit
PPO, Premier.
You may see any dentist; however, your out-of-pocket expenses will likely be less if you see a Delta Dental network dentist
*Requires annual contract
Approx $32.50/month
Individual
Patient Direct Discount Plan
None
$0
$0
No waiting periods
Payment is made directly from the patient to the providerPrices shown are a general dentist. A specialist reduces fees by 20-50%
Exams: up to $50
Cleanings: up to $50
Up to $50
Up to $195
Non-surgical extractions: up to $102
Root canal: up to $769
Crowns: up to $831
Removable dentures: up to $1,058
Surgical extractions: up to $370
Implant placement: $1,441
General dentist: up to $4,302
Specialist: Fees reduced by 20-50%
Not insurance — Delta Dental pays nothing
Delta Dental - Patient Direct.
Members must choose a primary network dental office to access the full benefits of the plan
No
$11.75/month
Subscriber only
Frame allowance
+ 20% savings on amounts over allowance
Contact lenses
instead of glasses
WellVision Exam
Contact lens exam
fitting & evaluation
Lenses
single vision, lined bifocal or trifocal, lenticular; standard progressives and polycarbonate for children
Anti-reflective coating
Scratch-resistant coating
Solid & gradient tints
Standard progressive lenses
multifocal
Glasses & sunglasses
Retinal screening
Laser vision correction
Network
Monthly
DeltaVision
Brilliance 200 Plan
+ 20% savings on amounts over allowance">$200
$110 at Costco in-store Optical Center
instead of glasses">$200
$0 copay
fitting & evaluation">$0 copay
single vision, lined bifocal or trifocal, lenticular; standard progressives and polycarbonate for children">$0 copay
$41
$0
$0
multifocal">$0
Extra $20 to spend on featured frame brands, and 20% savings on pairs of glasses and sunglasses including lens enhancements
No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam
Average 15% off regular price or 5% off promotional price
VSP Choice Network.
In-network providers only
An Additional $15.56/month
Individual
DeltaVision
Essential 150 Plan
+ 20% savings on amounts over allowance">$150
$80 at Costco in-store Optical Center
instead of glasses">$150
$10 copay
fitting & evaluation">Up to $40
single vision, lined bifocal or trifocal, lenticular; standard progressives and polycarbonate for children">$10 copay
$41
$17 - $33
$15 - $17
multifocal">$55
Extra $20 to spend on featured frame brands, and 20% savings on pairs of glasses and sunglasses including lens enhancements
No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam
Average 15% off regular price or 5% off promotional price
VSP Choice Network.
In-network providers only
An Additional $8.28/month
Individual
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