How an Individual Uses Dental Services
Dental care under the Dental II plan may be obtained from any provider you wish. However, how much you pay for care will depend on the tier level of the provider you choose.
Dental II is a 3 tier provider network within Delta Dental.
| Tier Level | Providers per Tier |
|---|---|
| Tier 1 | PPO network |
| Tier 2 | Regular Delta Dental network |
| Tier 3 | Dentists who do not participate with Delta Dental |
What is a PPO network?
PPO stands for Preferred Provider Organization. This means that any Delta Dental providers participating in the PPO or Regular Delta Dental network (Tier 1 and 2) will accept payment arrangements and file claims for you with Delta Dental of Iowa. Payment is made directly to these providers. A person using a PPO Delta Dental provider will see a reduced cost for care. Check the Delta Dental of Iowa website for a list of providers in the PPO and Regular network.
All of the other providers (Tier 3) are Non-participating providers and do not have contracts with Delta Dental of Iowa. They do not agree to accept payment arrangements and are not responsible for filing claims for you. Non-participating providers may charge more for dental care than participating providers. Payment is made to you and you are responsible for paying the provider.
The benefit period is the same as the calendar year.
How Much an Individual Pays for Dental Care Services
Diagnostic and Preventive Maintenance Care
| Benefit Period | Calendar Year |
|---|---|
| Annual Deductible (per member) | None |
| Co-insurance: Plan/Member | 100% / 0% |
| Maximum Annual Benefit (per member) | Two per year |
Diagnostic and Preventive Maintenance Care Benefits include:
- Routine examination
- Teeth cleaning
- Diagnostic services
- Special preventive care for children
- X-rays
Routine and Restorative Care
| Provider Tier | PPO | Premier | Non-participating |
|---|---|---|---|
| Annual Deductible (Per Member) | None | None | None |
| Co-insurance: Plan/Member | 100% / 0% | 80% / 20% | 80% / 20% |
| Maximum Annual Benefit (Per Member)* | $2000, up to $4000 with annual carryover | ||
Routine and Restorative Care includes:
- Regular cavity fillings
- Emergency treatment for relief of pain
- Routine oral surgery
- Anesthesia
- Extractions
Dental Prosthetics, Endodontic, Periodontal, and High Cost Restorations
| Provider Tier | PPO | Premier | Non-participating |
|---|---|---|---|
| Annual Deductible (Per Member) | None | None | None |
| Co-insurance: Plan/Member | 90% /10% | 80% / 20% | 80% / 20% |
| Maximum Annual Benefit (Per Member)* | $2000, up to $4000 with annual carryover | ||
Dental Prosthetics, Endodontic Services, Periodontal Services and High Cost Restorations include:
- Bridges, partial and complete dentures
- Crowns
- Root Canals
- Implants
Straighter Teeth (Orthodontic Care)
| Benefit Period | Calendar Year |
|---|---|
| Annual Deductible (per Member) | $0 |
| Coinsurance: Plan/Member | 50% / 50% |
| Maximum Annual Benefit (per Member)* | $2000, up to $4000 with annual carryover |
Straighter Teeth Care Include:
- Treatment necessary for the proper alignment of teeth
- Orthodontic benefits are paid quarterly
*Maximum Annual Benefit (per member):
$2,000 includes all covered services per member. The annual benefit maximum for Dental II includes a carryover feature from one calendar year to the next. If you do not use all of your $2,000 maximum, have been covered the full year, and submitted at least one claim, what remains will carryover and be added to your annual maximum in the following year up to $4,000.
ABOUT OUR SITE: The information presented on our website describes only the highlights of the plans and does not constitute official plan documents. Additional terms and conditions apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern.
ABOUT OUR SITE:
Our website's information describes only the highlights of the plans and does not constitute official plan documents. Additional terms and conditions may apply. If there are any discrepancies between the information contained herein and the official plan documents, the plan documents will govern. For more detailed information, you may contact Delta Dental of Iowa at number 800-544-0718 (TTY: 888-287-7312), Monday through Friday from 7:30 a.m. to 5:00 p.m. (central time). For more efficient service, please have your member ID number handy - you can find it on the front of your card.