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