| Dental Base Plan | Dental Buy-Up Plan | |||
|---|---|---|---|---|
|
| Delta Dental PPO In-Network Dentist | Delta Dental Premier Out-of-Network Dentist | PPO In-Network Dentist ONLY | |
| Deductible | $50/Individual $150/Family |
$50/Individual $150/Family |
||
| Benefit Maximum (calendar year) |
Plan pays $2,000/Individual |
Plan pays $3,000/Individual |
||
| Diagnostic and Preventive Benefits (oral exams, cleanings, X-rays, etc.)* |
No copay or deductible | Deductible applies | No copay or deductible | |
| Basic Benefits (oral surgery, fillings, root canals, etc.) |
You pay 20% | You pay 20% | ||
| Crowns, Other Cast Restorations | You pay 50% | You pay 40% | ||
| Prosthodontic (bridges, full and partial dentures) |
You pay 50% | You pay 40% | ||
| Dental Guards (once every three years) |
You pay 50%, Plan pays $500 maximum/Person | You pay 50%, Plan pays $500 maximum/Person | ||
| Retainer Replacement (once every five years) |
You pay 50%, Plan pays $500 maximum/Person | You pay 50%, Plan pays $500 maximum/Person | ||
| Implants | You pay 50% with a $2,000 lifetime max/Individual | You pay 40% with a $3,000 annual maximum/Individual | ||
| Orthodontic Benefits (adults and children) |
You pay 50% with a $2,000 lifetime max/Individual | You pay 40% with a $3,000 lifetime maximum/Individual | ||
* Not subject to benefit maximum.
Fees are based on Delta’s PPO fees for in-network dentists and the maximum plan allowance (MPA) for out-of-network dentists.
Buy-Up Plan
You have the option to buy a higher level of dental coverage in addition to the Basic Plan. This option offers more coverage for major services, higher annual maximums per patient, a $3,000 annual maximum for implants, and a higher lifetime maximum for orthodontics (see full comparison chart for more details).
Please note that the Delta Buy-Up coverage is only available with Delta PPO dentists. PPO Premier dentists are considered out-of-network and your Buy-Up coverage would not apply.
Carefully review the benefits of the Buy-Up Plan and weigh against the increased monthly premium for the plan.
In-Network vs. Out-of-Network Dentists
Under the Delta Dental PPO Plan, you can visit any licensed dentist but you save money when using dentists within the PPO Network since PPO dentists have lower contracted fees and may only charge a set amount. When seeing a PPO dentist you will receive free diagnostic and preventive care and pay less for basic benefits, crowns, and other services.
Out-of-Network dentists tend to charge higher rates, and Premier dentists have a higher contracted rate with Delta, and so you'll pay more out-of-pocket and meet your benefit maximum quicker.
Since you pay a percentage of the dental bill, it’s in your best interest to see in-network Delta Dental PPO providers in order to minimize your out-of-pocket costs and maximize your annual plan allowance.
Log in at deltadentalins.com to search for in-network PPO providers.
Dental Cost Estimator
Delta Dental has a new cost estimator tool to help you estimate your out-of-pocket expenses for dental procedures. Whether you’re getting braces or need a cavity filled, the tool will use real-time personalized data to estimate your expected out-of-pocket costs.
Log in to your account at deltadentalins.com and click on the Cost Estimator link by your name.
Dental ID Card
You will not receive an ID card for dental insurance. The dental or orthodontic office will locate your coverage based on your SSN and date of birth (DOB). However, you can log in at deltadentalins.com and print out an ID card with your Enrollee ID number if you prefer not to provide your dentist with your SSN and DOB.
Coordination of Benefits
If you are considering enrolling in Marvell's dental plan and a second dental plan through a spouse/domestic partner's employer, review this flyer for information on how coordinating two dental plans would work.
Submitting a Claim for Out-of-Network Services
If you or a dependent received dental services with an out-of-network provider, you can still submit a claim by following the below steps.
Members will need to complete the claim form which can be found on the Delta Dental site > proceed to 'Quick Links' at the bottom of the landing page > find the claim form titled 'Member Claim Form'. You can also download the form here.
Be sure to complete the top portion of the form with your member and/or dependent insurance information. You can attach the detailed treatment statement from your dental office along with the receipt/proof of payment to ease you from completing the full form. The Delta Dental claims processing team can then utilize the detailed statement to process the claim. Once the form is completed, you can mail it to the address found in box 3 of the form.
Please note, claims typically process within two weeks unless additional information is required from your or your dentist.
