Overview

We have dental coverage through Delta Dental of New York. With the Delta Dental of New York PPO plans, you can keep your teeth and gums healthy by getting a free preventative checkup two times each year. You also have the option of visiting a dentist virtually.

The Delta Dental network is made up of a national group of providers that have contracted to deliver their services at a reduced cost. Participating providers are screened and selected by Delta Dental and must meet pre-established certification standards.

Your group number is 04811. Our dental PPO plans are “passive”, meaning you can go to any dentist you’d like; however, you may pay more with out-of-network dentists. Using in-network dentists will lower your out-of-pocket costs; using out-of-network services gives you even more dentists to choose from but requires you to pay more. If you’d like to find an in-network dentist in your area, you can follow these steps:

  1. Go to Delta Dental
  2. Look for the “Find a Dentist” portal
  3. Enter your location, choose your network and enter any relevant keywords
  4. Click “Search”

Your dental plan options are

Basic PPO Plan

designed for participants who expect to need only basic services

Comprehensive PPO Plan

designed for participants who who expect to need comprehensive dental coverage

Key features at a glance:

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Flexible PPO designs

that let you go to any dentist you choose.

Affordable coverage

that helps you manage the cost of dental treatment.

Wide network of providers

that have agreed to negotiated rates, which helps you save money.

In-network cost savings

You pay less when you use a Delta Dental in-network doctor.

Visit a dentist virtually

You can connect with a dentist instantly, which allows you to get urgent dental care, prescriptions and just easier access all around for your dental care needs.

 

Coverage details

Below is a snapshot of dental coverage, and you can find the full coverage listed in the Dental Summary Plan Description. As a best practice, we recommend reviewing your coverage plan before getting service.

Services covered under both the Basic PPO Plan and Comprehensive PPO Plan include:

  • Preventive/Diagnostic — including periodic exams, certain x-rays and cleanings
  • Basic — fillings, root canal therapy for anterior and bicuspids, periodontal treatment, and extractions

Services only covered under the Comprehensive PPO Plan include:

  • Major — crowns and dentures, molar root canal, osseous surgery, partial and full bone impactions, crown-lengthening and core build-up
  • Orthodontia — corrective dentistry for children and adults
 Basic PPO Plan Comprehensive PPO Plan
Cleanings per calendar yearTwoTwo
Annual deductible for individual/family$100/$300$50/$150
Annual maximum$1,000 per person$2,000 per person
Services
Preventive100% covered by plan; not subject to deductible and annual maximum benefit100% covered by plan; not subject to deductible and annual maximum benefit
BasicYou pay 50% after deductibleYou pay 20% after deductible
Major servicesNot coveredYou pay 50% after deductible*
Orthodontia coinsurance/lifetime maximumNot covered$2,000

*Note that the replacement of, addition to, or modification of existing dentures, crowns, casts or bridgework is subject to certain conditions and limitations. Contact Delta Dental at 1-800-932-0783 if you need dental work for a pre-existing condition, or visit Delta Dental.

 

Using your dental plan

Here’s how to make the most of your dental benefits

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Choose any provider.

Each time you need dental care, you have a choice of providers. Selecting a Delta Dental participating dentist will ensure you receive the highest benefits from your plan. To find a provider, go to Delta Dental.

Present your plan identification information

at your provider’s office. The Dental Plan group number is 04811.

If your service will exceed $500, request a pre-treatment estimate.

We recommend requesting for a pre-treatment estimate for procedures and services your dentist believes will exceed $500 (e.g., crowns, inlays, bridges, periodontics). For more guidance, call Delta Dental at 1-800-932-0783 or visit Delta Dental.

Review your claim status and other information at Delta Dental.

Find out what you owe or already paid. See what your plan paid. And check the amount you have left to meet your deductible. Your Explanation of Benefits (EOB) shows all of your claims and statements.

Nominate your dentist to join the Delta Dental network.

You can nominate your dentist to join the Delta Dental network if you’d like to receive our in-network benefits. Visit Delta Dental to get started, and select either the PPO or Premier option to access an online form that you can complete. Delta Dental will take it from there. (Please note: We cannot guarantee that your dentist will join the Delta Dental network after you nominate them.)

Member support

For a listing of in-network dentists in your area, call toll-free 1-800-932-0783 or visit Delta Dental. Your group number is 04811.