Delta Dental of Oklahoma The University of Oklahoma The University of Oklahoma



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IMPORTANT: The University of Oklahoma has elected to issue a unique nine-digit number to identify each Delta Dental subscriber enrolled under the OU plan. By using your unique plan identity code, you will not need to present or refer to your social security number. Please refer to your specific alternate I.D. number for all Delta Dental transactions, including enrollment to Spotlight, visits to the dentist, etc. For more information please contact your benefits administrator.

Your Dental Programs

Delta Dental is pleased to provide dental benefits for employees of The University of Oklahoma. This Web site provides a brief description of the most important features of your Delta Dental of Oklahoma dental benefits program. For more specific questions regarding your benefits, please contact our friendly Customer Service Department at 800-522-0188 (Toll Free) or 405-607-2100 (OKC Metro).

Delta Dental of Oklahoma offers two customized programs to all employees of The University of Oklahoma. Whether selecting the Basic Plan or the Alternate Plan, the member has access to the Delta Dental PPO network and the Delta Dental Premier network (our largest network).

In addition, the covered services are the same under both plans, including family orthodontics. The only differences between the two plans are the co-payment percentages, deductibles, and maximum benefit payments. Under the Alternate Plan, the co-payment percentages and the maximum benefit payments the plan pays are higher, and the deductible the participant pays is lower.

Delta Dental PPO – Point of Service program includes both the Delta Dental PPO and Premier networks under one program, maximizing network savings while increasing network access.

  • One program with access to both the PPO and Premier network
  • Provider reimbursements based on network utilized
  • Additional out-of-pocket savings when utilizing a PPO network provider
  • No balance-billing for either network
  • Pre-existing conditions covered
  • Claim filing by participating dentist
Option 1: Delta Dental PPO – Point of Service (Basic Plan)

The Basic Plan is a lower cost plan that utilizes both networks, with the co-payments and maximum benefit payments slightly lower than the Alternate Plan.

Click Here for a Detailed Benefit Summary


BENEFIT PLAN
Delta Dental PPO Delta Dental Premier Out of Network
 
Diagnostic & Preventive-Class I 90% 75% 75%
Basic Restorative-Class II 80% 75% 75%
Major Restorative-Class III 50% 50% 50%
Orthodontics-Class IV 50% 50% 50%
 
Deductible: $50 Per Person
$100 Per Family
$50 Per Person
$100 Per Family
$50 Per Person
$100 Per Family
Applies to: Classes II & III Only Classes II & III Only Classes II & III Only
 
Maximum Benefit Payment: $1,000 Per Person Per Benefit Year for Class I, Class II, and Class III Services Combined.

$1,500 Lifetime Maximum Benefit Payment Per Eligible Person for Class IV Services.

Notes:  Deductibles do not apply to Class I and Class IV Services

Participating provider reimbursement based on provider network utilized, non-network provider reimbursement based on the prevailing fee

Benefits payable by the Plan for covered oral evaluations (examinations), procedure codes D0120-D0180, and routine prophylaxis (cleaning), procedure codes D1110 and D1120, will not reduce the maximum benefit payment per person during the benefit year for combined Class I, Class II, and Class III covered dental services

Option 2: Delta Dental PPO – Point of Service (Alternate Plan)

The Alternate Plan is richer in benefits than the Basic Plan.

Click Here for a Detailed Benefit Summary


BENEFIT PLAN
Delta Dental PPO Delta Dental Premier Out of Network
 
Diagnostic & Preventive-Class I 100% 100% 100%
Basic Restorative-Class II 90% 80% 80%
Major Restorative-Class III 60% 50% 50%
Orthodontics-Class IV 50% 50% 50%
 
Deductible: $25 Per Person
$75 Per Family
$25 Per Person
$75 Per Family
$25 Per Person
$75 Per Family
Applies to: Classes II & III Only Classes II & III Only Classes II & III Only
 
Maximum Benefit Payment: $2,000 Per Person Per Benefit Year for Class I, Class II, and Class III Services Combined.

$1,500 Lifetime Maximum Benefit Payment Per Eligible Person for Class IV Services.

Notes: Deductibles do not apply to Class I and Class IV Services

Participating provider reimbursement based on provider network utilized, non-network provider reimbursement based on the prevailing fee

Benefits payable by the Plan for covered oral evaluations (examinations), procedure codes D0120-D0180, and routine prophylaxis (cleaning), procedure codes D1110 and D1120, will not reduce the maximum benefit payment per person during the benefit year for combined Class I, Class II, and Class III covered dental services

The information contained herein is not intended as a Summary Plan Description, nor is it designed to serve as Evidence of Coverage for this program. Benefits for some covered services may be subject to waiting periods or limitations such as age of patient, frequency of procedure, etc., or excluded in some instances. If you have specific questions about your dental benefits, consult your Summary Plan Description, or call 405-607-2100 (OKC Metro) or 800-522-0188 (Toll Free). You may write Delta Dental of Oklahoma at P.O. Box 54709, Oklahoma City, Oklahoma 73154-1709.