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RWJBH Plan Information

Benefit Summaries & Plan Comparison

PPO Network

Using a PPO dentist is considered in-network and will offer you the greatest savings on dental services and will maximize your benefits.

Premier Network

Using a Premier dentist is considered in-network and will offer you great savings on dental services. It is the largest network.

Out of Network

You have the freedom to choose any dentist that does not participate in either the PPO or Premier networks.

Plan Comparison


	Base Plan		Buy-Up Plan
Service	In-Network (PPO/Premier)	Out-of-Network	In-Network (PPO/Premier)	Out-of-Network
Preventive & Diagnostic Exams, cleanings, bitewing x-rays, sealants, space maintainers Fluoride treatments (frequency limitations apply)	100%/100%	100%	100%/100%	100%
Basic Filings, simple extractions, root canals (endodontics) Periodontics, oral surgery	80%/80%	80%	80%/80%	80%
Major Crowns & gold restorations, bridgework Full & partial dentures, repair of dentures	50%/50%	50%	50%/50%	50%
	50%/50%	50%	50%/50%	50%
Annual Maximum (per person)	$1,500/$1,500	$1,500	$2,000/$2,000	$2,000
Annual Deductible Per person Family maximum Waived for	$75 $225 Preventive & Diagnostic		$50 $150 Preventive & Diagnostic
Orthodontics Adult & child to age 26 Lifetime maximum	50% $1,500		50% $2,000
	Download Summary		Download Summary

* Dependent children are covered until the end of the month, when they turn 26.
Please be advised: If you use an out-of-network provider, you may be balanced billed by the provider.

Calendar year maximums and deductibles are not separate across our networks and will cross-accumulate if you see dentists in different networks throughout the year.
In-network dentists won’t “balance bill” patients. This means dentists can’t charge you the difference between their usual fee and the amount they’ve agreed to accept as payment from Delta Dental.

If you have any questions regarding your benefits, you may contact our Customer Service Department Monday through Thursday, 8:00 a.m. to 6:30 p.m. EST, and Friday, 8:00 a.m. to 5:00 p.m. EST, at 1-800-810-5234.

Illustrative out-of-pocket fee for getting a crown

	Dentist's charge	Sample Delta Dental fees	Member Co-insurance	Delta Dental Pays	Balance billed amount	Amount you pay out of pocket
PPO Network	$1,438	$790	50%	$395	$0	$395 ($790 - $395)
Premier Network	$1,438	$930	50%	$395	$140	$535 ($930 - $395)
Non-Participating	$1,438	$790	50%	$395	$648	$1,043 ($1,438 - $395)