Dental
Plan/Group Number 05479
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Delta Dental
Delta Dental
What You Need To Know
Keep your smile looking its brightest with the help of Delta Dental. You have a choice of two plans: the Synopsys Low Dental Plan and the Synopsys High Dental Plan.
Highlights
The plans allow you to see any licensed dentist, but they pay increased benefits when you use a Delta Dental PPO dentist. If you use non-Delta dentists, you’re responsible for your percentage share, plus any amounts the dentist charges above the usual, customary, and reasonable (UCR) rate.
Before getting treatment for more than $300, have your dentist submit a predetermination of benefits to Delta Dental so you’ll know how much your plan will pay and the portion you’ll be responsible for.
Benefits and Covered Services
Synopsys Low Dental Plan
| Network | PPO Dentists | Premier and Non-PPO Dentists |
|---|---|---|
| Calendar-Year Deductible | $50 per person $100 per family | $50 per person $100 per family |
| Calendar-Year Benefit Maximum | $1,500 per person | $1,500 per person |
| Diagnostic and Preventive Services (exams, cleanings, X-rays, sealants) | You pay 0% — deductible does not apply | You pay 0% — deductible does not apply |
| Basic Services (fillings, simple tooth extractions, endodontics) | You pay 20% after deductible | You pay 30% after deductible |
| Major Services (crowns, inlays, onlays and cast restorations, bridges and dentures, implants) | You pay 50% after deductible | You pay 50% after deductible |
| TMJ Benefit | You pay 20% after deductible | You pay 30% after deductible |
| Orthodontic Benefits for Adults and Dependent Children | Not covered | Not covered |
| Orthodontic Maximum | Not covered | Not covered |
Synopsys High Dental Plan
| Network | PPO Dentists | Premier and Non-PPO Dentists |
|---|---|---|
| Calendar-Year Deductible | None | $50 per person $100 per family |
| Calendar-Year Benefit Maximum | $2,500 per person | $2,500 per person |
| Diagnostic and Preventive Services (exams, cleanings, X-rays, sealants) | You pay 0% — deductible does not apply | You pay 0% — deductible does not apply |
| Basic Services (fillings, simple tooth extractions, endodontics) | You pay 10% | You pay 20% after deductible |
| Major Services (crowns, inlays, onlays and cast restorations, bridges and dentures, implants) | You pay 40% | You pay 50% after deductible |
| TMJ Benefit | You pay 10% | You pay 20% after deductible |
| Orthodontic Benefits for Adults and Dependent Children | You pay 50% | You pay 50% |
| Orthodontic Maximum | $2,500 lifetime | $2,500 lifetime |
Did Your Dentist Drop Delta?
If your dentist no longer accepts Delta Dental insurance, you can search for a new in-network provider by visiting Delta Dental.
Add More Convenience to Your Dental Care
- Get a virtual dental screening from a Delta Dental PPO or Premier dentist by using the quip app. Just answer a few questions about your oral health and take photos of your mouth from your smartphone to receive a personalized assessment report within 24 hours. To get started, visit the Delta Dental website to register and create an account. Then, download the quip app to your smartphone or tablet, and log in to schedule your appointment.
- Get a real-time video appointment with a PPO or Premier Delta Dental dentist who can provide urgent care, an e-prescription (sent right to your pharmacy), or a dental check-in through a virtual dental consult. Best of all, there’s no cost to you.
- Manage your dental benefits through the Delta Dental website. You may register to view your policy information, check the status of a claim, or gain access to your enrollment information and print out an ID card.