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Delta Plans Fully Insured through Delta
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Plan A |
Plan B |
Plan C |
Plan D |
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Delta Dental PPO |
Delta Dental PPO |
Delta Dental PPO |
Delta Dental PPO |
| |
PPO Dentist |
Premier or
Nonpar |
PPO Dentist |
Premier or Nonpar |
PPO Dentist |
Premier or Nonpar |
PPO Dentist |
Premier or
Nonpar |
| Class I Benefits |
| Diagnostic Services |
100% |
100% |
100% |
100% |
50% |
50% |
100% |
75% |
| Preventive Services |
100% |
100% |
100% |
100% |
50% |
50% |
100% |
75% |
| Emergency Palliative Tratment |
100% |
100% |
100% |
100% |
50% |
50% |
100% |
50% |
| Radiographs |
100% |
100% |
100% |
100% |
50% |
50% |
100% |
75% |
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| Class II Benefits |
| Oral Surgery |
90% |
80% |
80% |
50% |
50% |
50% |
50% |
50% |
| Minor Restorative Services |
90% |
80% |
80% |
50% |
50% |
50% |
50% |
50% |
| Endodontic Services |
90% |
80% |
80% |
50% |
50% |
50% |
50% |
50% |
| Periodontic Services |
90% |
80% |
80% |
50% |
50% |
50% |
50% |
50% |
| Relines and Repairs |
90% |
80% |
80% |
50% |
50% |
50% |
50% |
50% |
| TMD Treatment |
60% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
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| Class III Benefits |
| Prosthodontic Services |
60% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
| Major Restorative Services |
60% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
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| Class IV Benefits |
Orthodontic Services
( to age 26) |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
50% |
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| Maximum Benfits per person |
Per Calendar Year
(Class I, II, & III) |
1,500 |
1,200 |
1,000 |
1,000 |
Lifetime Maximum
for Class IV |
1,000 |
1,000 |
1,000 |
1,000 |
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Welcome to the St. Clair Shores Police Officers who re-joined our coverage as of August 1st, 2011
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