Under this Delta Dental plan, you may see any dentist. However, your out-of-pocket costs are lower when you use a dentist on Delta's Preferred Provider Option (PPO) list. Once you meet the deductible, you will be responsible for a percentage of your covered costs, known as coinsurance. Adults, age 19 or older, are eligible for the orthodontic benefit with this plan.
- CU Health Plan - Choice Dental Benefits Coverage Summary (1 page)
- CU Health Plan - Choice Dental Full Benefits Booklet (21 pages)
- Right Start 4 Kids Program (1 page)
|Features and Considerations|
|Plan Type||PPO Provider Network||Premier Provider Network**||Non-Participating***|
|Plan Year Benefit||$2,500*||$2,500*||$2,500*|
|Deductible (Children 12 and under exlcuded)||$25 per person||$75 per peson||$75 per person|
|Preventative & Diagnostic Services||0% coinsurance and no deductible||0% coinsurance and no deductible||0% coinsurance and no deductible|
|Basic Services||20-25% coinsurance||40-50% coinsurance||40-50% coinsurance|
|Major Services||25% coinsurance||60% coinsurance||60% coinsurance|
|Orthodontics||40% coinsurance after deductible||60% coinsurance after deductible||60% coinsurance after deductible|
|* Combination of in and out-of-network services.
** The Premier percentage of benefits is limited to the Premier Maximum Plan Allowance.
|*** The non-participating percentage of benefits is limited to the non-participating Maximum Plan Allowance. You will be responsible for the difference between the non-participating Maximum Plan Allowance and the full fee charged by the dentist.|