Dental

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 CareWaivedWaived
Calendar Year Out-of-Pocket Maximum
Regular Services$1,000 per Person$1,250 per Person
Covered Services
Preventative Services90%100%
Basic Services70%80%
Major Services50%50%
Orthodontia (coverage for dependent children to age 19)Not Covered50%
Orthodontic Lifetime MaximumNot Covered$2,000 per Dependent
Covered Services & Frequency Limitations
Oral Examinations1 in 6 months
Full Mouth X-rays 1 in 36 months
Bitewing X-rays
(Adult/Child)
1 in 6 months
Cleanings1 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 TierLow PlanHigh 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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