Delta Dental of TN
Brighter Advantage
- No waiting periods on most benefits
- Orthodontia coverage for all members after 12 months
- Benefits increase after the first year
- Annual maximums increase to $1000 in the second year; $1250 in the third year; and $1500 in the fourth year
- Cosmetic procedures such as teeth whitening and veneers are covered
- Access to more than 100,000 Delta Dental PPO providers nationwide and more than 70% of the practicing dentists in Tennessee
- Underwritten by Delta Dental of Tennessee
This dental program allows members to utilize any licensed provider. Members who choose a Delta Dental PPO network provider have the lowest out of pocket expenses and cannot be balance billed.
| Common procedures: | |
|---|---|
| Cleaning: | 100% |
| White Filling: | 50-80% |
| Crown: | 25-50% |
| Root Canals: | 25-50% |
| Simple Extractions: | 50-80% |
| Plan Maximum: | $750 – year 1, $1000 – year 2, $1250 – year 3, $1500 – year 4 (+) per contract year. $1000 Lifetime Maximum for Orthodontic benefits |
| Waiting Periods: | No waiting periods for Preventive, Basic and Major Services. Orthodontia – 12-month wait |
| Deductible: | $50 per person per benefit year, $150 maximum per family. Applies to all services except in-network diagnostic and preventive services |
| Details: |
|---|
| Fee Schedule: N/A | Dentist Search | Exams: |
| Routine periodic examinations – two times in any 12 month period In-Network: 100% Out-of-Network: 80% after deductible Preventive – No waiting period | Cleanings: |
| Teeth Cleanings – two times in any 12 month period In-Network: 100% Out-of-Network: 80% after deductible Preventive – No waiting period | X-Rays: |
| Bite-wing x-rays, one set in a 12 month period Full mouth x-rays, once within 3 years In-Network: 100% Out-of-Network: 80% after deductible Preventive – No waiting period | Fillings: |
| Restorative Amalgam Fillings, Resin-based composite (white fillings) – once per surface in a 24 month period In-Network: 1st year – 50% after deductible 2nd year and after – 80% after deductible Out-of-Network: 1st year – 40% after deductible 2nd year and after – 60% after deductible Basic – No waiting period | Extractions: |
| Simple Extractions In-Network: 1st year – 50% after deductible 2nd year and after – 80% after deductible Out-of-Network: 1st year – 40% after deductible 2nd year and after – 60% after deductible Basic – No waiting period | Crowns: |
| In-Network: 1st year – 25% after deductible 2nd year and after – 50% after deductible Out-of-Network: 1st year – 10% after deductible 2nd year and after – 40% after deductible Major – No waiting period | Root Canals: |
| Endodontia – treatment of the dental pulp (root canal procedures) – once in a 24 month period In-Network: 1st year – 25% after deductible 2nd year and after – 50% after deductible Out-of-Network: 1st year – 10% after deductible 2nd year and after – 40% after deductible Major – No waiting period | Dentures: |
| In-Network: 1st year – 25% after deductible 2nd year and after – 50% after deductible Out-of-Network: 1st year – 10% after deductible 2nd year and after – 40% after deductible Major – No waiting period | Deep Cleanings: |
| Scaling and root planning procedures are allowed once within 24 month In-Network: 1st year – 25% after deductible 2nd year and after – 50% after deductible Out-of-Network: 1st year – 10% after deductible 2nd year and after – 40% after deductible Major – No waiting period | Implants: |
| The surgical placement of a endosteal (in the bone) implant and the connecting abutment In-Network: 1st year – 25% after deductible 2nd year and after – 50% after deductible Out-of-Network: 1st year – 10% after deductible 2nd year and after – 40% after deductible Major – No waiting period | Braces/Orthodontia: |
| Orthodontic benefits are available to all ages under this plan In-Network: 1st year - Not Covered Service 2nd year and after – 50% after deductible Out-of-Network: 1st year – Not Covered Service 2nd year and after – 40% after deductible $1000 Lifetime Maximum Orthodontia – 12-month waiting period | Teeth Whitening: |
| External bleaching procedures are covered once per 12 month period per arch; internal bleaching procedures are covered once per tooth per 12 month period In-Network: 1st year – 25% after deductible 2nd year and after – 50% after deductible Out-of-Network: 1st year – 10% after deductible 2nd year and after – 40% after deductible Major – No waiting period | Additional Network Information: |
Delta Dental of Tennessee’s Individual & Family Plans cover your annual preventive care — 100%. This means there is no out-of-pocket cost when visiting a Delta Dental PPO℠ dentist for your annual exams and cleanings. Diagnostic & Preventive services are excluded from your deductible when using Delta Dental’s PPO providers — routine cleanings do not apply to your deductible. That helps your benefits stretch as wide as your smile. Access Delta Dental PPO℠ network nationwide. This is access to our greatest discounts available at more than 72% of dental offices in Tennessee. With more than 108,800 dentists nationwide, our network probably includes your dentist. You also have access to care when traveling through our national networks. Each in-network dentist goes through a credentialing process to ensure they meet Delta Dental’s high standards. NOTE: Certain limitations apply. See the Schedule of Benefits for complete details. Delta Dental participating network count, July 2018. Exclusions and LimitationsHIPAA Privacy Notice Privacy Policy Plan Brochure |
FAQ:
Can I change my dentist once I am in the plan?
Yes, you may change your dentist at any time. Your out of pocket expenses may be less if you choose a Delta Dental PPO provider.
What is a pre-existing condition versus work-in-progress? Is it covered?
A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program. The plan does not include an exclusion for pre-existing conditions.
Work in progress is any oral health procedure that is started and not completed prior to your enrollment in a dental program. The plan does not cover any expenses prior to the date you are covered under the Policy.
What provider options do I have?
You have freedom to choose any dentist but visiting Delta Dental PPO dentist gives you great advantage of our negotiated rates with network dentists. The fees charged by in-network dentists are pre-established by Delta Dental, meaning less out-of-pocket costs for you.
Diagnostic & Preventive services are excluded from your deductible when using Delta Dental’s PPO providers — routine cleanings do not apply to your deductible. That helps your benefits stretch as wide as your smile.
When can I start using my Plan?
Enjoy your benefits after your effective date — the first day of the month following receipt of application, $25 application fee, and initial premium if received on or before the 15th of the month. If received after the 15th, effective date will be the first day of the following month.
When will I receive my new member kit and what will it include?
You will receive your electronic enrollment package upon completion of enrollment and payment of applicable premiums/enrollment fees, or a few days prior to the selected effective date. This enrollment package will include your policy and temporary I.D. cards. You will receive a Welcome Packet in the mail within 4-6 weeks.
Who can enroll in this plan?
Coverage is offered to Tennessee residents who are 18 years of age or older plus their eligible dependents (spouse and children from birth to age 26).
240 Venture Circle
Nashville, TN 37228
Disclaimers and Disclosures:
Delta Dental of Tennessee: Delta Dental of Tennessee offers three options designed exclusively for individuals or families who don't have access to a group dental plan where they work. These plans are also available to retirees and their families who no longer have group coverage. Plans are a 12-month contract and offered to Tennessee residents only. These plans are officially endorsed by Delta Dental of Tennessee.
This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.
Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.
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