| Plan Details | ||
|---|---|---|
| Plan Name | DeltaCare USA DHMO | |
| Effective Dates | Jan 01, 2025 to Jan 01, 2026 | |
| Benefits | In-Network | |
| Annual Deductible/Individual | $0 | |
| Annual Deductible/Family | $0 | |
| Annual Plan Maximum | None | |
| Diagnostic and Preventive Services | Copays vary between $0 and $45 depending on specific service | |
| Basic Services | Copays vary between $0 and $220 depending on specific service | |
| Major Services | Copays vary between $0 and $195 depending on specific service | |
| Orthodontia Services | Copays vary between $0 and $1900 depending on specific service | |