Dental Plan Benefits
Maximum Lifetime Benefit
(for Plan A only) | Plan A
Implants: $5,000 per individual per lifetime (based on 50% of reasonable and customary charges, up to $2,500 per year)
Orthodontia: $2,500 per individual per lifetime up to the age of 19. |
| Maximum Annual Benefit | Plan A and Plan B: None. |
| Calendar-Year Deductible | Plan A and Plan B: No deductible. |
| Preferred Provider |
The Delta Preferred Option USA Plus Plan (DPO Plus) is provided by Delta Dental of Massachusetts. Dentists who participate in the DPO Plus Plan will:
- Accept fees determined by Delta Dental Plan.
- File claims directly with Delta Dental.
- Locate a participating provider at: www.deltadentalma.com
The DPO Plus Plan leverages two of Delta’s dental networks – Delta Preferred Option and Delta Premier. Members recognize the greatest savings when using a Delta Preferred Option dentist, but can also enjoy value when receiving services from a Delta Premier dentist.
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| Pre-Treatment Estimates | You are encouraged to have your dentist submit a request for a pre-treatment estimate for any services that are likely to total $300 or more. See the Summary Plan Description for complete details. |
| What the DPO Plus Plan Covers | Click here for a benefits overview. Complete details are available in the Summary Plan Description |
| Filing a Claim | If you use a participating dentist there is no need to file a claim. If you go to a non-participating dentist, you must return a dental form (available at http://www.deltadentalma.com) within 90 days of the date of service to Delta Dental. |
| Summary Plan Description |
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