HALO offers two Dental PPO (DPPO) plans. Your Delta Dental DPPO plan allow you to use any licensed provider. There is a network of dentists that have contracted with Delta Dental. Using a provider which is part of that network will result in greater benefits and lower member costs. Use of out-of-network providers is allowed, but members will be responsible for greater cost sharing and may be subject to balance billing. Refer to this example for additional details of why it is important to find an in-network provider.
For additional plan details, please refer to the plan documents under the “Plan Documents & Contact Information” section below.
Dental Benefit Highlights
| In-Network & Out-of-Network* | Low Plan | High Plan |
| Calendar Year Deductible |
| Individual | $100 | $50 |
| Family | $300 | $150 |
| Preventive Care | Waived | Waived |
| Calendar Year Out-of-Pocket Maximum |
| Regular Services | $1,000 per Person | $1,250 per Person |
| Covered Services |
| Preventative Services | 90% | 100% |
| Basic Services | 70% | 80% |
| Major Services | 50% | 50% |
| Orthodontia (coverage for dependent children to age 19) | Not Covered | 50% |
| Orthodontic Lifetime Maximum | Not Covered | $2,000 per Dependent |
| Covered Services & Frequency Limitations |
| Oral Examinations | 1 in 6 months |
| Full Mouth X-rays | 1 in 36 months |
Bitewing X-rays
(Adult/Child) | 1 in 6 months |
| Cleanings | 1 in 6 months |
*Delta Dental PPO dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s allowed PPO fee. PPO network dentists cannot charge you for costs exceeding the PPO fee.
*Delta Dental Premier dentists accept payment based on the lesser of the submitted fee (their usual fee) or Delta Dental’s maximum plan allowance. Premier dentists may not charge you for costs exceeding the maximum plan allowance.
The amounts below represent the employee bi-weekly contribution for the Dental Plans.
| Coverage Tier | Low Plan | High Plan |
| Employee Only | $11.36 | $13.70 |
| Employee + Spouse | $20.46 | $24.66 |
| Employee + Child(ren) | $28.06 | $39.84 |
| Employee + Family | $39.43 | $53.55 |
Plan Documents & Contact Information
Plan Documents
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