California Group Plans

Rates Benefits Plan Rules EZ Enroll

Delta PPO Benefits

Delta Preferred Provider Option (PPO) is Delta's preferred provider program. The program provides the maximum benefit when you visit a PPO Dentist. PPO dentists are Delta dentists who have agreed to charge PPO patients reduced fees. Under the PPO program, you may visit any licensed dentist you wish. However, you receive the maximum benefits available under the program when you choose one of the more than 11,000 in-network dental offices throughout California. 44% of California Dentists are Delta Preferred Providers.

Delta Dental PPO Dentist Search For a printed list please call Delta at: (800) 4-AREA-DR (800-427-3237)

Plan 1500 PPO Option II PPO Option III Use Any Dentist
Calendar Year Deductible $50.00*
*Deductible waived for items covered at 100%		 In Network Out of Network In Network Out of Network In Network Out of Network
Preventive and Diagnostic
(frequencies shown below) Emergency treatment for relief of pain, Routine Exams, Cleaning, Bitewing X-rays, Full Mouth X-rays, Fluoride Treatment, Space Maintainers 		100% 100% 100% 100% 100% 100%
Basic Dental Services
Restorative - Amalgam or Synthetic Fillings
Sealants (frequencies shown below)
Oral Surgery
Extractions, Impacted Teeth, Cysts and Neoplasms, Alveolar/Gingival Reconstructions
Periodontics - Includes treatment for diseases of the gums
Endodontics - Root canals and Pulpal Therapy 		80% 80% 80% 50% 80% 50%
Major Dental Services
(Subject to a 12 month waiting period.)

Effective March 1, 2002, All new groups with 20 or more employees enrolling in any Wolfpack Insurance Services Delta Dental plan will automatically have the waiting period for Major and Orthodontic services waived.

For groups of 5 employees or more, the 12 month waiting period for Major Dental Services will be waived on all employees who had continuous dental coverage during the preceding 12 months. The 12 month Orthodontic waiting period will also be waived if the group had continuous orthodontic coverage during the preceding 12 months.

Restorative - Inlays and Crowns
Prosthodontics - Dentures and Partials

 50% 50% 50%
Calendar Year Maximum, Benefit per Individual
 $1500 $1500 $1000
Option Orthodontic Benefit
Maximum lifetime benefit of $1500. Subject to a 12 month waiting period. Utilize any provider.		 50% 50% 50%