Small Group Pediatric EHB Benefit Summaries
(2-9)
Annual maximum
(per covered person)
PPO/Premier
& OON
None
Maximum annual out of pocket
PPO/Premier
& OON
1 child/2 or more children
$350/
$700 or
No Limit
for Premier
and OON
Deductible
PPO/Premier
& OON
(applied to P&D)
$135/
$405
Annual maximum
(per covered person)
PPO/Premier
& OON
None
Maximum annual out of pocket
PPO/Premier
& OON
1 child/2 or more children
$350/
$700 or
No Limit
for Premier
and OON
Deductible
PPO/Premier
& OON
(not applied to P&D)
$35/
$105
Annual maximum
(per covered person)
PPO/Premier
& OON
None
Maximum annual out of pocket
PPO/Premier
& OON
1 child/2 or more children
$350/
$700 or
No Limit
for Premier
and OON
Deductible
PPO/Premier
& OON
(applied to P&D)
$135/
$405
Annual maximum
(per covered person)
PPO/Premier
& OON
None
Maximum annual out of pocket
PPO/Premier
& OON
1 child/2 or more children
$350/
$700 or
No Limit
for Premier
and OON
Deductible
PPO/Premier
& OON
(not applied to P&D)
$35/
$105
This is a summary of deductible, coinsurance, out-of-pocket limits, and other components of plan design. All coverage provisions, limitations and exclusions can be found in the group contract and certificate of coverage. Some Covered Services for Pediatric Enrollees require that you obtain a Prior Authorization from us before the service is performed. The covered dental services that require Prior Authorization are described in the certificate of coverage. Where Prior Authorization is required but not obtained, Delta Dental can apply a penalty of up to 50% of the charges that would otherwise be covered.
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.
