Dental
Your smile is one of your best features, and dental health is important to your overall health. Allegion’s dental coverage through Delta Dental covers a full range of services — preventive, basic and major care and orthodontia — to help you keep your teeth and gums healthy and looking good.
You may receive care from in- and out-of-network providers, but you’ll pay less when you use dentists in the network. Please go to deltadentalin.com/Member/Using-Your-Benefits/Find-a-Dentist to search for in-network providers. For Delta Dental of Indiana, your group number is 1290, and your Social Security number is used as your member ID.
You have choices when it comes to your dental coverage. You can select the DPPO Plan or the DPPO Buy-Up, which comes with a greater calendar year maximum and lifetime orthodontic maximum. You make this choice during Annual Enrollment each fall or if you experience a qualifying life event during the year.
Group 1290
| DPPO Plan | DPPO Buy-Up Plan | |
|---|---|---|
| In-Network | In-Network | |
| You Pay | ||
| Calendar Year Plan Maximum | ||
| Per Individual | $1,750 per individual (Basic and Major Services combined) | $2,000 per individual (Basic and Major Services combined) |
| Calendar Year Deductible | ||
| Individual | $50 | $50 |
| Family | $150 | $150 |
| Preventive Care | ||
| Exams, Cleanings, X-rays | $0, covered at 100% | $0, covered at 100% |
| Basic Services | ||
| Fillings, Sealants, Extractions, Emergency Exams | 20%* | 20%* |
| Major Procedures | ||
| Crowns, Inlays/Onlays, Dentures and Bridgework, Repairs | 50%* | 50%* |
| Orthodontia | ||
| Adults | Not covered | 50% up to a lifetime maximum benefit of $2,000 per individual; deductible waived |
| Children (up to 19th birthday) | 50% up to a lifetime maximum benefit of $1,750 per individual; deductible waived | |
| DPPO Plan | |
|---|---|
| In-Network | |
| You Pay | |
| Calendar Year Plan Maximum | |
| Per Individual | $1,750 per individual (Basic and Major Services combined) |
| Calendar Year Deductible | |
| Individual | $50 |
| Family | $150 |
| Preventive Care | |
| Exams, Cleanings, X-rays | $0, covered at 100% |
| Basic Services | |
| Fillings, Sealants, Extractions, Emergency Exams | 20%* |
| Major Procedures | |
| Crowns, Inlays/Onlays, Dentures and Bridgework, Repairs | 50%* |
| Orthodontia | |
| Adults | Not covered |
| Children (up to 19th birthday) | 50% up to a lifetime maximum benefit of $1,750 per individual; deductible waived |
| DPPO Buy-Up Plan | |
| In-Network | |
| You Pay | |
| Calendar Year Plan Maximum | |
| Per Individual | $2,000 per individual (Basic and Major Services combined) |
| Calendar Year Deductible | |
| Individual | $50 |
| Family | $150 |
| Preventive Care | |
| Exams, Cleanings, X-rays | $0, covered at 100% |
| Basic Services | |
| Fillings, Sealants, Extractions, Emergency Exams | 20%* |
| Major Procedures | |
| Crowns, Inlays/Onlays, Dentures and Bridgework, Repairs | 50%* |
| Orthodontia | |
| Adults | 50% up to a lifetime maximum benefit of $2,000 per individual; deductible waived |
| Children (up to 19th birthday) | |
Things You Should Know
- You can see any dentist, but you may pay more if you use an out-of-network dentist.
- There are no ID cards — simply tell your dentist you have Delta Dental coverage, and they will check your eligibility.
Contact Delta Dental
Delta Dental
Group 1290
1-800-524-0149
deltadentalin.com