Delta Preferred - PPO
- Deductible for Management groups - $25 (in-network) or $35 (out-of-network)
- Deductible for non-management groups - $40 (in-network) or $50 (out-of-network)
- Diagnostic and Preventative services covered at 100%
- Two cleanings per year
- Bitewing x-rays once per year
- Full mouth x-rays every 3 years
- Basic services covered at 80%
- Crowns and other cast restorations covered at 50%
- Prostodontics covered at 50%
- Annual maximum benefit for services per person, per calendar year - $1,000
- No orthodontia benefit
Employee Only - $52.51
Employee & Family - $101.91
Delta Preferred Management Summary
Delta Preferred Non-Management Summary
DeltaCare USA - HMO
- Deductible - $0
- Cleanings & Exams - eligible once every 6 months at no cost to employee
- Fee schedule for services
- Orthodontia benefit for children or adolescent to age 19 - $1,600
- Orthodontia benefit for adults, including adult children - $1,800
- Metallic fillings covered, ceramic or porcelain are a materials upgrade at employee expense