2-9 Enrolled Employee Plans

Preventive & Diagnostic Only

NJ PPO 1A  (PDF, 1 page, 1.84 MB)
$500 Calendar Year Maximum (per enrollee)
NJ PPO 1B  (PDF, 1 page, 1.84 MB)
$750 Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 1A  (PDF, 1 page, 1.41 MB)
$750 PPO/$500 Non-PPO Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 1B  (PDF, 1 page, 1.41 MB)
$1,000 PPO/$750 Non-PPO Calendar Year Maximum (per enrollee)


Preventive, Diagnostic & Basic Services

NJ PPO 2A  (PDF, 1 page, 1.41 MB)
100/80/0 | $1,000 Calendar Year Maximum (per enrollee)
NJ PPO 2B  (PDF, 1 page, 1.41 MB)
100/80/0 | $1,250 Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 2A  (PDF, 1 page, 1.84 MB)
100/80/0 | $1,000 PPO/$750 Non-PPO Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 2B  (PDF, 1 page, 1.84 MB)
100/80/0 | $1,250 PPO/$1,000 Non-PPO Calendar Year Maximum (per enrollee)


Preventive, Diagnostic, Basic Services & Major Services

NJ PPO 3A  (PDF, 2 pages, 1.43 MB)
100/80/50 | $1,500 Calendar Year Maximum (per enrollee)
NJ PPO 3B  (PDF, 2 pages, 1.43 MB)
100/80/50 | $2,000 Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 3A  (PDF, 2 pages, 1.44 MB)
100/80/50 | $1,500 PPO/$1,000 Non-PPO Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 3B  (PDF, 2 pages, 1.43 MB)
100/80/50 | $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum (per enrollee)
NJ PPO 5A   (PDF, 2 pages, 1.43 MB)
100/100/60 | $1,500 Calendar Year Maximum (per enrollee)
NJ PPO 5B  (PDF, 2 pages, 1.43 MB)
100/100/60 | $2,000 Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 5AA  (PDF, 2 pages, 1.46 MB)
100/100/60 | $1,500 PPO/$1,000 Non-PPO Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 5AB  (PDF, 2 pages, 1.46 MB)
100/100/60 | $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum (per enrollee)
NJ PPO Plus Premier 5BA  (PDF, 2 pages, 1.46 MB)
100/100/60 | $1,500 PPO/$1,000 Non-PPO Calendar Year Maximum (per enrollee)
NJ Plus Premier 5BB  (PDF, 2 pages, 1.46 MB)
100/100/60 | $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum (per enrollee)

10-49 Enrolled Employee Plans

Preventive & Diagnostic Only

NJ PPO 1A  (PDF, 1 page, 1.84 MB)
100/0/0 |$500 Calendar Year Maximum
NJ PPO 1B  (PDF, 1 page, 1.84 MB)
100/0/0| $750 Calendar Year Maximum
NJ PPO Plus Premier 1A  (PDF, 1 page, 1.41 MB)
100/0/0 | $750 PPO/$500 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 1B  (PDF, 1 page, 1.41 MB)
100/0/0 | $1,000 PPO/$750 Non-PPO Calendar Year Maximum

Preventive, Diagnostic & Basic Services

NJ PPO 2A  (PDF, 1 page, 1.41 MB)
100/80 | $1,000 Calendar Year Maximum
NJ PPO 2B  (PDF, 1 page, 1.41 MB)
100/80 | $1,250 Calendar Year Maximum
NJ PPO Plus Premier 2A  (PDF, 1 page, 1.41 MB)
100/80 | $1,000 PPO/$750 Non-PPO Calendar Year Maximum
NJ Plus Premier 2B  (PDF, 1 page, 1.41 MB)
100/80 | $1,250 PPO/$1,000 Non-PPO Calendar Year Maximum

Preventive, Diagnostic, Basic Services & Major Services

NJ PPO 3A  (PDF, 2 pages, 1.46 MB)
100/80/50 | $1,500 Calendar Year Maximum
NJ PPO 3B  (PDF, 2 pages, 1.46 MB)
100/80/50 | $2,000 Calendar Year Maximum
NJ PPO Plus Premier 3A   (PDF, 2 pages, 1.46 MB)
100/80/50 | $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 3B  (PDF, 2 pages, 1.46 MB)
100/80/50 | $3,000 PPO/$2,500 Non-PPO Calendar Year Maximum
NJ PPO 5AA  (PDF, 2 pages, 1.46 MB)
100/100/60 | $50 Deductible/$1,500 Calendar Year Maximum
NJ PPO 5AB   (PDF, 2 pages, 1.47 MB)
100/100/60 | $50 Deductible/$2,000 Calendar Year Maximum
NJ PPO 5BA   (PDF, 2 pages, 1.46 MB)
100/100/60 | $75 Deductible/$1,500 Calendar Year Maximum
NJ PPO 5BB   (PDF, 2 pages, 1.46 MB)
100/100/60 | $75 Deductible/$2,000 Calendar Year Maximum
NJ PPO Plus Premier 5AA   (PDF, 2 pages, 1.46 MB)
100/100/60 | $50 Deductible -- $1,500 PPO/$1,000 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 5AB   (PDF, 2 pages, 1.46 MB)
100/100/60 | $50 Deductible -- $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 5BA   (PDF, 2 pages, 1.46 MB)
100/100/60 |$75 Deductible -- $1,500 PPO/$1,000 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 5BB   (PDF, 2 pages, 1.46 MB)
100/100/60 |$75 Deductible -- $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum

Preventive, Diagnostic, Basic Services & Major Services w/ Orthodontics

NJ PPO 4A   (PDF, 2 pages, 1.47 MB)
100/80/50/50 | $1,500 Calendar Year Maximum
NJ PPO 4B   (PDF, 2 pages, 1.47 MB)
100/80/50/50 | $2,000 Calendar Year Maximum
NJ PPO Plus Premier 4A   (PDF, 2 pages, 1.47 MB)
100/80/50/50 | $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 4B   (PDF, 2 pages, 1.47 MB)
100/80/50/50 | $3,000 PPO/$2,500 Non-PPO Calendar Year Maximum
NJ PPO 6AA   (PDF, 2 pages, 1.47 MB)
100/100/60/50 | $50 Deductible/$1,500 Calendar Year Maximum
NJ PPO 6AB  (PDF, 2 pages, 1.47 MB)
100/100/60/50 | $50 Deductible/$2,000 Calendar Year Maximum
NJ PPO 6BA  (PDF, 2 pages, 1.47 MB)
100/100/60/50 | $75 Deductible/$1,500 Calendar Year Maximum
NJ PPO 6BB  (PDF, 2 pages, 1.47 MB)
100/100/60/50 | $75 Deductible/$2,000 Calendar Year Maximum
NJ PPO Plus Premier 6AA  (PDF, 2 pages, 1.47 MB)
100/100/60/50 | $50 Deductible -- $1,500 PPO/$1,000 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 6AB  (PDF, 2 pages, 1.47 MB)
100/100/60/50 | $50 Deductible -- $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 6BA  (PDF, 2 pages, 1.47 MB)
100/100/60/50 |$75 Deductible -- $1,500 PPO/$1,000 Non-PPO Calendar Year Maximum
NJ PPO Plus Premier 6BB  (PDF, 2 pages, 1.47 MB)
100/100/60/50 |$75 Deductible -- $2,000 PPO/$1,500 Non-PPO Calendar Year Maximum

Steerage Plans:
Preventive, Diagnostic, Basic Services & Major Services

NJ PPO AA  (PDF, 2 pages, 1.46 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50
$1,500 PPO/$1,000 Non-PPO Calendar Year Max
NJ PPO AB  (PDF, 2 pages, 1.46 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50
$2,000 PPO/$1,500 Non-PPO Calendar Year Max
NJ PPO CA  (PDF, 2 pages, 1.46 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50
$2,000 Calendar Year Max
NJ PPO CB  (PDF, 2 pages, 1.46 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50
$2,500 Calendar Year Max
NJ PPO Plus Premier AA  (PDF, 2 pages, 1.47 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50
$1,500 PPO/$1,000 Non-PPO Calendar Year Max
NJ PPO Plus Premier AB  (PDF, 2 pages, 1.47 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50
$2,000 PPO/$1,500 Non-PPO Calendar Year Max
NJ PPO Plus Premier AC  (PDF, 2 pages, 1.47 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50
$3,000 PPO/$2,500 Non-PPO Calendar Year Max
NJ PPO Plus Premier CA   (PDF, 2 pages, 1.47 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50
$1,500 PPO/$1,000 Non-PPO Calendar Year Max
NJ PPO Plus Premier CB  (PDF, 2 pages, 1.47 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50
$2,000 PPO/$1,500 Non-PPO Calendar Year Max
NJ PPO Plus Premier CC  (PDF, 2 pages, 1.47 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50
$2,500 PPO/$2,000 Non-PPO Calendar Year Max

Steerage Plans:
Preventive, Diagnostic, Basic Services & Major Services w/ Orthodontics

NJ PPO BA (Steerage)  (PDF, 2 pages, 1.47 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50 | Ortho - 50
$1,500 PPO/$1,000 Non-PPO Calendar Year Max
NJ PPO BB (Steerage)  (PDF, 2 pages, 1.473 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50 | Ortho - 50
$2,000 PPO/$1,500 Non-PPO Calendar Year Max
NJ PPO BC  (PDF, 2 pages, 1.473 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50 | Ortho - 50
$3,000 PPO/$2,500 Non-PPO Calendar Year Max
NJ PPO DA  (PDF, 2 pages, 1.47 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50 | Ortho - 50
$2,000 Calendar Year Max
NJ PPO DB  (PDF, 2 pages, 1.47 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50 | Ortho - 50
$2,500 Calendar Year Max
NJ PPO Plus Premier BA  (PDF, 2 pages, 1.47 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50 | Ortho - 50
$1,500 PPO/$1,000 Non-PPO Calendar Year Max
NJ PPO Plus Premier BB  (PDF, 2 pages, 1.47 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50 | Ortho - 50
$2,000 PPO/$1,500 Non-PPO Calendar Year Max
NJ PPO Plus Premier BC  (PDF, 2 pages, 1.47 MB)
P&D - 100/80/80 | Basic Services - 80/60/60 | Major Services - 50 | Ortho - 50
$3,000 PPO/$2,500 Non-PPO Calendar Year Max
NJ PPO Plus Premier DA  (PDF, 2 pages, 1.47 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50 | Ortho - 50
$1,500 PPO/$1,000 Non-PPO Calendar Year Max
NJ PPO Plus Premier DB  (PDF, 2 pages, 1.47 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50 | Ortho - 50
$2,000 PPO/$1,500 Non-PPO Calendar Year Max
NJ PPO Plus Premier DC  (PDF, 2 pages, 1.47 MB)
P&D - 100 | Basic Services - 100/80/80 | Major Services - 60/50/50 | Ortho - 50
$2,500 PPO/$2,000 Non-PPO Calendar Year Max

50+ Enrolled Employee Plans

50+ Products 50+ Underwriting Guidelines  (PDF, 1 page, 60.3 KB)

For more information or to receive your customized quote,
please contact Ryan Doyle (rdoyle@deltadentalnj.com).

Voluntary Plans
2-49 Enrolled Employees

Preventive & Diagnostic Only

NJ PPO Voluntary 1A (2-9)  (PDF, 1 page, 1.84 MB)
100 |$500 Calendar Year Maximum | waiting period may apply
NJ PPO Voluntary 1B (2-9)  (PDF, 1 page, 1.84 MB)
100| $750 Calendar Year Maximum | waiting period may apply
NJ PPO Voluntary 1A (10-49)  (PDF, 1 page, 1.84 MB)
100 |$500 Calendar Year Maximum | waiting period may apply
NJ PPO Voluntary 1B (10-49)  (PDF, 1 page, 1.84 MB)
100 |$750 Calendar Year Maximum | waiting period may apply
NJ PPO Plus Premier Voluntary 1A (10-49)  (PDF, 1 page, 1.41 MB)
100 |$500 Calendar Year Maximum | waiting period may apply
NJ PPO Plus Premier Voluntary 1B (10-49)  (PDF, 1 page, 1.41 MB)
100 |$750 Calendar Year Maximum | waiting period may apply

Preventive, Diagnostic, Basic Services & Major Services

NJ PPO Voluntary 2 (2-9)  (PDF, 2 pages, 1.43 MB)
100/80/50 | $1,000 Calendar Year Maximum | waiting period may apply
NJ PPO Voluntary 2 (10-49)  (PDF, 2 pages, 1.43 MB)
100/80/50 | $1,000 Calendar Year Maximum | waiting period may apply
NJ PPO Plus Premier Voluntary 2 (10-49)  (PDF, 1 pages, 1.43 MB)
100/80/50 | $1,000 Calendar Year Maximum | waiting period may apply