| Plan Details | ||
|---|---|---|
| Plan Name | Delta Dental High | |
| Effective Dates | Jul 01, 2023 to Jan 01, 2025 | |
| Benefits | In-Network | Out-of-Network |
| Annual Deductible/Individual | $0 | $50 |
| Annual Deductible/Family | $0 | $150 |
| Annual Plan Maximum | $1,500 | $1,500 |
| Lifetime Orthodontia Plan Maximum | $2,000 | $2,000 |
| Diagnostic and Preventive Services | 0% | 0% |
| Basic Services | 20% | 40% after deductible |
| Major Services | 40% | 50% after deductible |
| Orthodontia Services | 50% | 50% |
| Ortho Dependent Children | covered | covered |
| Ortho Adults (and Covered Full-Time Students, if Eligible) | covered | covered |