Learn about your plan

2

You can visit any licensed dentist

Visit a PPO dentist to save the most.

You won’t be charged more than your expected share of the bill.

Your smile is coveredDelta Dental PPO

3

You don’t need an ID card to check in.

We’ll coordinate dual coverage.

Create an online account to check your benefits and claims online.

Your smile is coveredDelta Dental PPO

Pre-treatment estimateIt’s easy to plan for dental expenses

1ST

2ND

3RD

Ask your dentist for an estimate

Dentist sends details to Delta Dental

You and your dentist receive a cost estimate

Emergency coverage

• Visit any dentist worldwide and receive benefits

• Submit a claim for reimbursement

Your PPO coverageDeductibles and maximums

Delta Dental PPOBasic Plan – MUST USE PPO Provider

Comprehensive Plan

DeductiblePer calendar yearWaived for D&P

$50 per person$150 per family

$50 per person$150 per family

Annual maximumPer calendar year

$1,000 per person $1,500 per person

OrthodonticLifetime maximum

Not covered $1,000 per person

Your PPO coverageWhat’s covered: Diagnostic & preventive care

Delta Dental PPOBasic – MUST USE PPO Dentist Comprehensive

Dental exam Plan pays 100% Plan pays 100%

Child cleaning Plan pays 100% Plan pays 100%

Adult cleaning Plan pays 100% Plan pays 100%

Sealants(under age 14)

Plan pays 100% Plan pays 100%

Fluoride treatment(under age 19)

Plan pays 100% Plan pays 100%

Your PPO coverageWhat’s covered: Basic services

Delta Dental PPOPPO – MUST USE PPO Dentist

Comprehensive PPO

Comprehensive Non-PPO

Amalgam (silver) filling, back tooth Plan pay 50% Plan pays 90% Plan pays 80%

Resin (white) filling, front tooth Plan pays 50% Plan pays 90% Plan pays 80%

Root canal, back tooth Plan pays 50% Plan pays 90% Plan pays 80%

Periodontal scaling and root planing Plan pays 50% Plan pays 90% Plan pays 80%

Oral surgery Plan pays 50% Plan pays 90% Plan pays 80%

Your PPO coverageWhat’s covered: Major services and prosthodontics

Delta Dental PPOPPO – MUST USE PPO Dentist

Comprehensive PPO

Comprehensive – Non-PPO

Crown (porcelain to high noble metal)

Not covered Plan pays 60% Plan pays 50%

Complete upper denture Not covered Plan pays 60% Plan pays 50%

Complete lower denture Not covered Plan pays 60% Plan pays 50%

Bridge Not covered Plan pays 60% Plan pays 50%

Dental implant Not covered Plan pays 60% Plan pays 50%

Your PPO coverageWhat’s covered: Orthodontics

Delta Dental PPOPPO Standard PPO Enhanced

Comprehensive orthodontics (child)*

Not covered Plan pays 50%

Comprehensive orthodontics (adult)

Not covered Plan pays 50%

Retention Not covered Plan pays 50%

Value-added features

Access hearing aid and LASIK discountsNow available to you and your dependents

62% average savings off retail hearing aid pricing

Amplifon Hearing Health Care

40-50% off traditional LASIK eye surgeryQualSight

How to get started with AmplifonSimply call or register online

Or go online at amplifonusa.com/

deltadentalins

Answer questions and make an appointment.

You and your provider will get

required info.

Call Amplifon at

888-779-1429

A Patient Care

Advocate will guide

you.

Amplifon will activate your hearing aid discounts.

Get started with QualSightTo sign up, call or register online at qualsight.com/-delta-dental

Call QualSight at 855-248-2020 or register online.

When you call, a care manager will explain the program details.

Choose a physician and pay a discounted price

for LASIK.

1. Get ready 2. Get set 3. Save!

Web/mobile resources

Check out the websitedeltadentalins.com

Search for a network dentist in your area.

Get answers to common questions about your dental plan.

Read articles, browse recipes and watch videos about oral health on the SmileWay® Wellness site.

Subscribe to Grin!, our quarterly wellness e-magazine.

Check your plan details: eligibility, covered services and level of benefits.

Look up claim statements for recent dental visits.

View or print your ID card.

Estimate the cost of your next procedure.

Submit questions to Customer Service.

Sign up for an online accountCheck your benefits information online

Convenience. Get an email alert every time a new document is available.

Efficiency. No need to wait for “snail mail.”

Save paper. Reduce your ecological footprint.

Log in to your account at deltadentalins.com, click on the My Profile tab and select the Online setting.

Go paperlessView your documents online: claims, pre-treatment estimates and plan details

Go mobileDownload the app to have all the information you need at your fingertips

Find a dentist

Coveragedetails

Electronic ID card

Costestimator

Musical timer

What can you do with the app?

✓ ✓ ✓ ✓ ✓

To find the app, visit the App Store or Google Play and search for “Delta Dental.” Then download the Delta Dental app by Delta Dental Plans Association.

Call us toll-free at 800-471-7091

Speak to a Customer Service representative Monday through Friday, 8 AM to 8 PM EST.

For simple questions, use our automated phone system, available 24/7

Ask online: Go to deltadentalins.com > Contact Us > Delta Dental of Pennsylvania > Customer Service Form

Get help by phone or online

Contact Customer Service

We’re pleased to take your questions

Thanks for your time