Small Group PPO Plus Premier Benefit Summaries
(10-50)
PPO Plus Premier
3
100/80/50 plan
with 5 maximum options
Calendar year maximum
PPO/Premier & OON
per enrollee
$1,000/
$750,
$1,500/
$1,000,
$2,000/
$1,500,
$3,000/
$2,500 or
$5,000/
$4,500
Deductible
PPO/Premier & OON
per person/per family
(excluding P&D)
$50/
$150
PPO Plus Premier
5
100/100/60 plan
with 3 maximum options
Calendar year maximum
PPO/Premier & OON
per enrollee
$1,500/
$1,000,
$2,000/
$1,500 or
$5,000/
$4,500
Deductible
PPO
per person/per family (excluding P&D)
Premier & OON
per person/per family (excluding P&D)
$50/$150
$75/$225
PPO Plus Premier
A
100/80/50 & 80/60/50 plans
with 3 maximum options
Calendar year maximum
PPO/Premier & OON
per enrollee
$1,500/
$1,000,
$2,000/
$1,500 or
$3,000/
$2,500
Deductible
PPO
per person/per family (excluding P&D)
Premier & OON
per person/per family (excluding P&D)
$50/$150
$75/$225
PPO Plus Premier
C
100/100/60 & 100/80/50 plans
with 4 maximum options
Calendar year maximum
PPO/Premier & OON
per enrollee
$1,500/
$1,000,
$2,000/
$1,500,
$2,500/
$2,000,
$3,000/
$2,500 or
$5,000/
$4,500
Deductible
PPO
per person/per family (excluding P&D)
Premier & OON
per person/per family (excluding P&D)
$50/$150
$75/$225
Calendar year maximum
PPO/Premier & OON
per enrollee
$2,000/
$1,500,
$3,000/
$2,500 or
$5,000/
$4,500
Deductible
PPO/Premier & OON
per person/per family (excluding P&D)
$50/
$150
Reimbursement for dentists that are not in the Delta Dental network is based on up to the 90th percentile of the UCR
* These are benefit highlights only. Additional exclusions and limitations may apply. Monthly premiums shown are examples only of our lowest monthly rates per employee for employee only coverage. Actual rates vary based on plan choice, your location, and number of people insured. For full details of plans, benefits and pricing, please contact one of our account executives.
The Special Health Care Needs Benefit from Delta Dental: Helping to break down barriers to care by providing eligible covered members with an enhanced benefit
Combining Deltavision with your Delta Dental benefits provides you with the convenience and affordability of two excellent programs in a single package
"Virtual Visits" service is provided by Teledentistry.com. This service is a covered benefit in most Delta Dental of New Jersey plans for currently enrolled members.
We've partnered with Amplifon Hearing Health Care to offer members access to a NO-COST hearing savings program that brings members huge savings on hearing aids and services.
