Your Dental Program

 

 

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Your Dental Program

Delta Dental is pleased to provide dental benefits for employees of members of the Oklahoma State Medical Association. This website provides a brief description of the most important features of your Delta Dental of Oklahoma dental benefits program. For more specific questions regarding your benefits, please contact our friendly Customer Service Department at 800-522-0188 (Toll Free) or 405-607-2100 (OKC Metro).

The Delta Dental PPO – Plus Premier program includes both the Delta Dental PPO and Delta Dental Premier networks under one program, maximizing network savings while increasing network access.

  • One program with access to both the PPO and Premier network
  • Provider reimbursements based on network utilized
  • Additional out-of-pocket savings when utilizing a PPO network provider
  • No balance-billing for either network
  • Pre-existing conditions covered
  • Claim filing by participating dentist
Delta Dental PPO – Plus Premier

Click Here for a Detailed Benefit Summary

Click Here for the Update/Enrollment Form

 
BENEFIT PLAN
Delta Dental PPO Delta Dental Premier Out of Network
 
Diagnostic & Preventive-Class I 100% 100% 100%
Basic Restorative-Class II 80% 80% 80%
Major Restorative-Class III 50% 50% 50%
Orthodontic - Class IV N/A N/A N/A
 
Deductible: $50 Per Person
$100 Per Family
Per Benefit Year
$50 Per Person
$100 Per Family
Per Benefit Year
$50 Per Person
$100 Per Family
Per Benefit Year
Applies to: Classes I, II & III Classes I, II & III Classes I, II & III
 
Maximum Benefit Payment: $1,500 Per Person Per Benefit Year for Class I, Class II, and Class III Services Combined.
 
Notes:  Deductible applies to all Class I, Class II, and Class III covered services except the 2 periodic oral evaluations (exams) and the 2 'routine' prophylaxis (cleanings) covered each plan benefit year.

Benefits payable by the Plan for covered oral evaluations (examinations), procedure codes D0120-D0180, and routine prophylaxis (cleaning), procedure codes D1110 and D1120, will not reduce the maximum benefit payment per person during the benefit year for combined Class I, Class II, and Class III covered dental services.

Provider reimbursement is based on the network utilized. Out-of-network reimbursement is based on prevailing fee.


The information contained herein is not intended as a Summary Plan Description, nor is it designed to serve as Evidence of Coverage for this program. Benefits for some covered services may be subject to waiting periods or limitations such as age of patient, frequency of procedure, etc., or excluded in some instances. If you have specific questions about your dental benefits, consult your Summary Plan Description, or call 405-607-2100 (OKC Metro) or 800-522-0188 (Toll Free). You may write Delta Dental of Oklahoma at P.O. Box 54709, Oklahoma City, Oklahoma 73154-1709.