NJCC dental plans
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NJCC dental plans - plan comparison |
| Service | Delta Dental PPO™ Low Plan | Delta Dental PPO™ Mid Plan | Delta Dental PPO Plus Premier™ High Plan | Flagship Voluntary NJ7 |
|---|---|---|---|---|
| P&D only plan | 100/50/50 plan design | 100/80/50 plan design | Member pays the amounts listed below | |
| Calendar year maximum (per person) | $500 | $1,000 | $1,500 | N/A |
| Calendar year deductible (waived on Preventive & Diagnostic) | ||||
| Per person | $0 | $50 | $50 | $0 |
| Family aggregate | $0 | $150 | $150 | $0 |
| Waiting period | None | None | None | None |
| Preventive & diagnostic | ||||
| Oral Exams and evaluations (consultations - combined with all other exams; emergency exams - combined with all other exams) | 100% | 100% | 100% | No cost |
| Cleanings/Prophylaxis (2 per calendar year) |
100% | 100% | 100% | No cost |
| Bitewing x‐rays (twice per calendar year for persons 18 and younger, once per calendar year for persons age 19 and over) | 100% | 100% | 100% | No cost |
| Full mouth X-rays or panoramic film (1 per 5 years) | 100% | 100% | 100% | No cost |
| Sealants (1 per lifetime per tooth (dependents through age 14) on permanent molars with no prior restorations on the “O” surface. Not covered in addition to resin fillings) | 100% | 100% | 100% | $30 per tooth |
| Topical flouride (2 per calendar year, to age 18) | 100% | 100% | 100% | No cost |
| Space maintainers (1 per arch, per lifetime, to age 13) | 100% | 100% | 100% | No cost |
| Basic services | ||||
| Fillings (Repeat restorations of same surface payable once in 2 years) | Not covered | 50% | 80% | No cost |
| Composite/resin restorations on second bicuspids and molars (including composite restorations on all teeth) | Not covered | 50% | 80% | No cost |
| Simple extractions (1 per lifetime per tooth) | Not covered | 50% | 80% | N/A |
| Root canal therapy (Endodontics) | Not covered | 50% | 80% | $185 - $285 |
| Periodontal maintenance (2 per calendar year. Periodontal maintenance is interchangeable with, but not in addition to, routine cleanings) | Not covered | 50% | 80% | $50 |
| Scaling and root planing (1 per 2 years per quadrant) | Not covered | 50% | 80% | $70 |
| Periodontal surgeries (gingivectomy, osseous surgery, flap surgery and grafts, etc. -1 per 3 years per quadrant. Note, frequencies vary by procedure code) | Not covered | 50% | 80% | $80 - $275 |
| Oral surgery (Frequencies vary by procedure code. If performed within 6 months of a major restoration or endodontic procedure no further benefits provided for the extraction.) | Not covered | 50% | 80% | No cost |
| General anesthesia or IV sedation (payable with covered oral surgery) | Not covered | 50% | 80% | No cost |
| Major services | ||||
| Single crowns (Replacement 1 in 5 years against itself or any other major services on the same tooth.) | Not covered | 50% | 50% | $100 - $290 |
| Stainless steel crowns (Replacement 1 in 2 years) | Not covered | 50% | 50% | $75 |
| Crown inlay, onlay, and veneer repairs (No frequency limitations) | Not covered | 50% | 50% | $270 |
| Crown recements (Replacement 1 in 5 years) | Not covered | 50% | 50% | No cost |
| Post and core (Payable 6 months after insertion then 1 in 12 months) | Not covered | 50% | 50% | $200 - $275 |
| Inlays (Given alternate benefit of a composite filling) | Not covered | 50% | 50% | No cost |
| Inlays/Onlays (If inlays are payable replacement 1 in 5 years; onlays are payable 1 in 5 years) | Not covered | 50% | 50% | $279 |
| Implants (Once every 60 months per tooth for ages 16 and older) | Not covered | 50% | 50% | N/A |
| Bridgework (abutment crowns and pontics; 1 per 5 years) | Not covered | 50% | 50% | $290 |
| Bridgework - recements (Not billable when performed within 6 months of initial placement by the same dentist/dental office, but then payable 1 per 12 months) | Not covered | 50% | 50% | No cost |
| Bridgework - repairs (Not billable within 12 months of the initial placement, but then payable 2 per 3 years) | Not covered | 50% | 50% | No cost |
| Full and partial dentures (1 placement per 5 years) | Not covered | 50% | 50% | $300 - $340 |
| Dentures - adjustments (Not billable when performed within 6 months of the initial placement by the same dentist/dental office, but then payable 2 in 12 months) | Not covered | 50% | 50% | No cost |
| Dentures - repairs, retines, rebases (Not billable when performed within 6 months of the initial placement by the same dentist/dental office, but then payable 1 in 6 months) | Not covered | 50% | 50% | $50 - $60 |
| Orthodontics | Children to age 26 | Adults & Children | ||
| Full comprehensive treatment | Not covered | Not covered | 50% | Covered |
| Lifetime Maximum | N/A | N/A | $1,500 | N/A |
| Out-of-Pocket Maximum | N/A | N/A | N/A | $2,900 |
Your dentist's network will impact how much you pay. Dentists that help participate in the Delta Dental PPO will have the lowest costs and will save you the most out-of-pocket expense. Dentists that participate in Delta Dental Premier, are participating Delta Dental dentists, but you will pay a greater portion of the cost if utilized. If you receive services from a non-participating, out-of-network dentists, you will pay the most out-of-pocket and are responsible for your coinsurance amount plus the difference between Delta Dental's approved fee and the dentist submitted fee for the claim.
