delta-dental-premier-diamond

Plan Highlights

  • Underwritten by Delta Dental Insurance Company
  • Free choice of Dentist
  • Benefits up to $2,000 per calendar year
  • Benefits increase after the first and second years
  • 6 month waiting period for basic procedures
  • 12 month waiting period for major procedures
  • Ortho lifetime maximum is $1,500
  • $25 copay per person per visit / $150 lifetime deductible for Ortho

Benefit Association Disclaimer

One time Non Refundable Processing fee: $35.00

The stated rates above include a four dollar ($4) per month billing fee, a four percent (4%) administration fee, and one dollar ($1) per month fee for membership in the Benefits Association. Membership in the Benefits Association, Inc. is required to enroll in this plan. Should you decide to enroll in this dental plan, you will be prompted during the enrollment process to confirm your acceptance of membership in the Benefits Association. If you are already a member of Benefits Association, please call the member services number located on the back of your membership card, and they will process your enrollment accordingly. Should your effective date fall on, or between, January 1st and June 1st, your policy will renew in January of each year, at which time rates may be subject to change. After your first renewal, the rates will be guaranteed for 12 months each year thereafter. If your effective date is on or between July 1st and December 1st, your policy will renew in July of each year, at which time rates may be subject to change. After your first renewal, the rates will be guaranteed for 12 months each year thereafter.


Benefits

Description Plan Pays Year 1 Plan Pays Year 2 Plan Pays Year 3
Diagnostic and Preventative Procedures Diagnostic: Routine periodic examinations twice in a calendar year. Preventative: Dental prophylaxis (teeth cleaning) twice in a calendar year. Radiography: Bitewing and full mouth x-rays. 80% 90% 100%
Basic Procedures (6 month waiting period) Restorative: Amalgam fillings. Other: Space maintainers, recementation of crowns. 60% 70% 80%
Major Procedures (12 month waiting period) Endodontics: Pulpal therapy and root canals. Periodontics: Treatment of diseases of the gums. Oral Surgery: Extractions and other oral surgery, including pre and post operative care. Prosthetics: Gold restorations, crowns, bridges, partials and complete dentures. Other: Pontics, repair of crowns and bridges, repair of full and partial dentures. 0% 40% 50%
Orthodontia Procedures (12 month waiting period) ($1,500 Lifetime Max, Limited to $450 per Calendar Year) Orthodontic benefits are only available for eligible dependent children. 0% 40% 50%
Deductible
$150 lifetime deductible for Ortho
Office Co-Pay
$25 Copay Per Person Per Visit

Methods of Payment

  • Visa
  • Mastercard
  • American Express
  • Discover
  • Bankdraft

Plan Disclosures

Yes. There are some limitations and exclusions with this plan, as with most group insurance policies. For a brief summary of the limitations and exclusions click here.