Preventive Prime
Summary of Coverage
|
Delta Dental
PPOTM Dentist
|
Delta Dental
Premier® Dentist
|
|
Deductible
per person per calendar year
|
$50 |
$50 |
$75 |
Annual Benefit Maximum
per person per calendar year
|
No coverage limit for routine and preventive care |
Benefit Categories
|
Coinsurance paid by member |
Diagnostic & Preventive Services
(check-ups, teeth cleaning, x-rays)
|
20% |
30% |
50% |
Routine & Restorative Services
(cavity repair, restoration of decayed or fractured teeth)
|
50% |
50% |
70% |
Posterior Composites
(tooth-colored filling on back teeth)
|
50% |
50% |
70% |
Additional Resources:
The information on this page summarizes your benefits and payment obligations. This is a general description of your benefits. Please see your benefits document for a full description of coverage.
Prime policies do not include the pediatric dental services as required under the Affordable Care Act (ACA). This coverage is available in the Plus policies. You can purchase policies with the required pediatric dental services on the insurance Marketplace and these plans can be purchased without purchasing a medical plan. Please contact Delta Dental, your insurance agent, or Iowa’s Health Insurance Marketplace if you wish to purchase pediatric dental coverage or a stand-alone dental policy.