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Delta Dental of TN
Superior Advantage

  • No waiting periods
  • 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
  • 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:$500 – year 1, $1000 – year 2, $1250 – year 3, $1500 – year 4 (+) per contract year
Waiting Periods:None
Deductible:$50 per person, $150 per family max, per contract year for all types of services, except Diagnostic and Preventive (when using Delta Dental’s PPO providers)
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:
Not Covered Service
Teeth Whitening:
Not Covered Service
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 Limitations
HIPAA 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).

Delta Dental of Tennessee
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.

This site was designed to provide you with a general description of the plans you requested. Keep in mind that it does not include all the benefits and limitations outlined in the policies -- it is the insurance contract, not the general descriptions on this website, which forms the contract between you and the insurance company.

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