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Group benefit summaries Oregon


Quickly and easily download everything you and your employees need for enrolling in a Delta Dental plan, filing claims and administering benefits.

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2022 Oregon Small Group dental plans (1-50)

Amounts are what members pay (in-network per person for ages 19+)



2022 Oregon
Plan Deductible Annual Max Exams and cleanings
Premier Plans
Delta Dental Premier®, 1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental Premier®, 1000, 80/80/50,50 $50 $1,000 20% after deductible
Delta Dental Premier®, 1500, 100*/80/50,25 $25 $1,500 0%
Delta Dental Premier®, 1500, 100*/80/50,50 $50 $1,500 0%
Delta Dental Premier®, 2000, 100*/80/50,50 $50 $2,000 0%
Delta Dental Premier® Shining Smiles $50 N/A Not covered
Premier Preventive First Plans
Delta Dental Premier® PF, 1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental Premier® PF, 1500, 100*/80/50, 50 $50 $1,500 0%
Premier Voluntary Plans
Delta Dental Premier®, Voluntary, 1000, 80*/80/50,50 $50 $1,000 20%
Delta Dental Premier®, Voluntary, 1000, 100*/80/50,50 $50 $1,000 0%
Delta Dental Premier®, Voluntary, 1500, 80*/80/50,50 $50 $1,500 20%
Delta Dental Premier®, Voluntary, 1500, 100*/80/50,50 $50 $1,500 0%
PPO Plans
Delta Dental PPOSM, 1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, 1000A, 100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, 1000B, 100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, 1500, 100*/80/50, 50 $50 $1,500 0%
Delta Dental PPOSM, 1500A, 100*/90/50, 50 $50 $1,500 0%
Delta Dental PPOSM, 1500B, 100*/80/50, 50 $50 $1,500 0%
Delta Dental PPOSM, 2000B, 100*/80/50, 50 $50 $2,000 0%
PPO MAC Plans
Delta Dental PPOSM MAC, 1500, 100*/60/50, 50 $50 $1,000 0%
PPO Preventive First Plans
Delta Dental PPOSM, PF, 1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, PF, 1000A, 100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, PF, 1000B, 100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, PF, 1500, 100*/80/50, 50 $50 $1,500 0%
Delta Dental PPOSM, PF, 1500A, 100*/90/50, 50 $50 $1,500 0%
Delta Dental PPOSM, PF, 1500B, 100*/80/50, 50 $50 $1,500 0%
PPO Voluntary Plans
Delta Dental PPOSM, Voluntary, 1000,100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, Voluntary, 1000,100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, Voluntary, 1500,100*/90/50, 50 $50 $1,500 0%
Delta Dental PPOSM, Voluntary, 1500,100*/80/50, 50 $50 $1,500 0%
EPO Plans
Delta Dental EPO, 1000,100*/80/50, 50 $50 $1,000 0%
Delta Dental EPO, 1000,100*/80/50, 50 $50 $1,500 0%
EPO Voluntary Plans
Delta Dental EPO, Voluntary, 1000,100*/80/50, 50 $50 $1,000 0%
Direct Option Plans
(with Willamette Dental Group) What employees pay (in-network, under age 19)
Deductible Annual Max Exams and cleanings
Direct Option 1I-IK No deductible $350 for one child; $700 for two or more children Covered at 100%
Direct Option 3I-IK No deductible Covered at 100%
Direct Option 5I-IK No deductible Covered at 100%
Direct Option 7I-IK No deductible Covered at 100%
Voluntary Direct Option Plans
(with Willamette Dental Group) What employees pay (in-network, under age 19)
Deductible Annual Max Exams and cleanings
Voluntary Direct Option 1I-IK No deductible $350 for one child; $700 for two or more children Covered at 100%
Voluntary Direct Option 2I-IK No deductible Covered at 100%
* Deductible waived for Class 1 services. PF means Class 1 does not apply to annual maximum
 
Plan Lifetime max Eligible employees Dependent children
Orthodontia riders
Adult & Child Ortho 1000 $1000 50% 50%
Adult & Child Ortho 1500 $1500 50% 50%
Child Ortho 1000 $1000 Not covered 50%1
Child Ortho 1500 $1500 Not covered 50%1
1 Covered only for children. Treatment must be started prior to child's 17th.




2021 Oregon Small Group dental plans (1-50)

Amounts are what members pay (in-network per person for ages 19+)

2021 Oregon
Plan Deductible Annual Max Exams and cleanings
Premier Plans
Delta Dental Premier®, 1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental Premier®, 1000, 80/80/50,50 $50 $1,000 20% after deductible
Delta Dental Premier®, 1500, 100*/80/50,25 $25 $1,500 0%
Delta Dental Premier®, 1500, 100*/80/50,50 $50 $1,500 0%
Delta Dental Premier®, 2000, 100*/80/50,50 $50 $2,000 0%
Delta Dental Premier® Shining Smiles $50 N/A Not covered
Premier Preventive First Plans
Delta Dental Premier® PF, 1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental Premier® PF, 1500, 100*/80/50, 50 $50 $1,500 0%
Premier Voluntary Plans
Delta Dental Premier®, Voluntary, 1000, 80*/80/50,50 $50 $1,000 20%
Delta Dental Premier®, Voluntary, 1000, 100*/80/50,50 $50 $1,000 0%
Delta Dental Premier®, Voluntary, 1500, 80*/80/50,50 $50 $1,500 20%
Delta Dental Premier®, Voluntary, 1500, 100*/80/50,50 $50 $1,500 0%
PPO Plans
Delta Dental PPOSM, 1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, 1000A, 100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, 1000B, 100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, 1500, 100*/80/50, 50 $50 $1,500 0%
Delta Dental PPOSM, 1500A, 100*/90/50, 50 $50 $1,500 0%
Delta Dental PPOSM, 1500B, 100*/80/50, 50 $50 $1,500 0%
Delta Dental PPOSM, 2000B, 100*/80/50, 50 $50 $2,000 0%
PPO MAC Plans
Delta Dental PPOSM MAC, 1500, 100*/60/50, 50 $50 $1,000 0%
PPO Preventive First Plans
Delta Dental PPOSM, PF, 1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, PF, 1000A, 100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, PF, 1000B, 100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, PF, 1500, 100*/80/50, 50 $50 $1,500 0%
Delta Dental PPOSM, PF, 1500A, 100*/90/50, 50 $50 $1,500 0%
Delta Dental PPOSM, PF, 1500B, 100*/80/50, 50 $50 $1,500 0%
PPO Voluntary Plans
Delta Dental PPOSM, Voluntary, 1000,100*/90/50, 50 $50 $1,000 0%
Delta Dental PPOSM, Voluntary, 1000,100*/80/50, 50 $50 $1,000 0%
Delta Dental PPOSM, Voluntary, 1500,100*/90/50, 50 $50 $1,500 0%
Delta Dental PPOSM, Voluntary, 1500,100*/80/50, 50 $50 $1,500 0%
EPO Plans
Delta Dental EPO, 1000,100*/80/50, 50 $50 $1,000 0%
Delta Dental EPO, 1000,100*/80/50, 50 $50 $1,500 0%
EPO Voluntary Plans
Delta Dental EPO, Voluntary, 1000,100*/80/50, 50 $50 $1,000 0%
Direct Option Plans
(with Willamette Dental Group) What employees pay (in-network, under age 19)
Deductible Annual Max Exams and cleanings
Direct Option 1H-HK No deductible $350 for one child; $700 for two or more children Covered at 100%
Direct Option 3H-HK No deductible Covered at 100%
Direct Option 5H-HK No deductible Covered at 100%
Direct Option 7H-HK No deductible Covered at 100%
Voluntary Direct Option Plans
(with Willamette Dental Group) What employees pay (in-network, under age 19)
Deductible Annual Max Exams and cleanings
Voluntary Direct Option 1H-HK No deductible $350 for one child; $700 for two or more children Covered at 100%
Voluntary Direct Option 2H-HK No deductible Covered at 100%
* Deductible waived for Class 1 services. PF means Class 1 does not apply to annual maximum
 
Plan Lifetime max Eligible employees Dependent children
Orthodontia riders
Adult & Child Ortho 1000 $1000 50% 50%
Adult & Child Ortho 1500 $1500 50% 50%
Child Ortho 1000 $1000 Not covered 50%1
Child Ortho 1500 $1500 Not covered 50%1
1 Covered only for children. Treatment must be started prior to child's 17th.

2022 Oregon large group plan material

Amounts are what members pay (in-network per person for ages 19+)

2022 large group plan material
Plan Deductible Annual Max Exams and cleanings
Premier Plans
B3X501 $50 $1,000 0%
B3X50 $50 $1,500 0%
B3X502 $50 $2,000 0%
B3X5025 $50 $2,500 0%
B3X503 $50 $3,000 0%
Premier Preventive First Plans
B3X501_PF $50 $1,000 0%
B3X50_PF $50 $1,500 0%
B3X502_PF $50 $2,000 0%
B3X5025_PF $50 $2,500 0%
B3X503_PF $50 $3,000 0%
Premier Voluntary Plans
VB3X501 $50 $1,000 0%
VB3X50 $50 $1,500 0%
PPO Plans
BP3X501 $50 $1,000 0%
BPB3X501 $50 $1,000 0%
BPA3X501 $50 $1,000 0%
BP3X50 $50 $1,500 0%
BPB3X50 $50 $1,500 0%
BPA3X50 $50 $1,500 0%
BP3X502 $50 $2,000 0%
BPB3X502 $50 $2,000 0%
BPA3X502 $50 $2,000 0%
BP3X5025 $50 $2,500 0%
BPB3X5025 $50 $2,500 0%
BPA3X5025 $50 $2,500 0%
BP3X503 $50 $3,000 0%
BPB3X503 $50 $3,000 0%
BPA3X503 $50 $3,000 0%
PPO Preventive First Plans
BP3X501_PF $50 $1,000 0%
BPB3X501_PF $50 $1,000 0%
BPA3X501_PF $50 $1,000 0%
BP3X50_PF $50 $1,500 0%
BPB3X50_PF $50 $1,500 0%
BPA3X50_PF $50 $1,500 0%
BP3X502_PF $50 $2,000 0%
BPB3X502_PF $50 $2,000 0%
BPA3X502_PF $50 $2,000 0%
BP3X5025_PF $50 $2,500 0%
BPB3X5025_PF $50 $2,500 0%
BPA3X5025_PF $50 $2,500 0%
BP3X503_PF $50 $3,000 0%
BPB3X503_PF $50 $3,000 0%
BPA3X503_PF $50 $3,000 0%
Voluntary Preferred Option Plans
VBP3X501 $50 $1,000 0%
VBPB3X501 $50 $1,000 0%
VBPA3X501 $50 $1,000 0%
VBP3X50 $50 $1,500 0%
VBPB3X50 $50 $1,500 0%
VBPA3X50 $50 $1,500 0%
Direct Option Plans
Direct Option 1I No deductible No annual maximum $15
Direct Option 3I No deductible No annual maximum $15
Direct Option 5I No deductible No annual maximum $25
Direct Option 7I No deductible No annual maximum $30
Voluntary Direct Option Plans
DO1IV No deductible No annual maximum $15
DO3IV No deductible No annual maximum $15
DO5IV No deductible No annual maximum $25
DO7IV No deductible No annual maximum $30
VD01I No deductible No annual maximum $15
VD02I No deductible No annual maximum $25
Plan Lifetime max Eligible employees Dependent children
Orthodontia riders
Adult & Child Ortho 1000 $1,000 50% 50%
Adult & Child Ortho 1500 $1,500 50% 50%
Adult & Child Ortho 2000 $2,000 50% 50%
Child Ortho 1000 $1,000 Not covered 50%1
Child Ortho 1500 $1,500 Not covered 50%1
Child Ortho 2000 $2,000 Not covered 50%1
Child Ortho 2500      
1Covered only for children. Treatment must be started prior to child's 17th birthday.


 
Plan Lifetime max Eligible employees Dependent children
Voluntary orthodontia riders
VC1000 $1,000 50% 50%1
VC1500 $1,500 50% 50%1
VAC1000 $1,000 50% 50%1
VAC1500 $1,500 50% 50%1
1Covered only for children. Treatment must be started prior to child's 17th birthday.


 

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