Close Icon Dismiss modal Close Icon Dismiss modal External Icon Link to an external resource Gear Icon Display options X Icon X Icon Plus Icon Minus Icon Arrow Right Arrow Left Arrow Up Arrow Down Calendar Edit Refresh First Last Question Info Block PDF PDF Document Word Word Document Excel Excel Document Powerpoint Powerpoint Document Active Checkbox Checked checkbox Active Radio Selected radio button Checkmark Error Warning Visibile Hidden

Small Group Benefit Summaries Oregon


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

View Benefit Summaries for:


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%
* 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.

2020 Oregon small group dental plans (1-50)

Amounts are what members pay (in-network per person for ages 19+)
Plan Deductible Annual Max Exams and cleanings
Premier Plans
Delta Dental Premier®, 1000, 100*/80/50, 25 $25 $1,000 0%
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 Preventative 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, 100*/80/50, 50 $50 $1,000 0%
Delta Dental Premier®, Voluntary, 1000, 80/80/50, 50 $50 $1,000 20% after deductible
Delta Dental Premier®, Voluntary, 1500, 100*/80/50, 50 $50 $1,500 0%
Delta Dental Premier®, Voluntary, 1500, 80/80/50, 50 $50 $1,500 20% after deductible
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, 25 $25 $1,500 0%
Delta Dental PPOSM, 1500A, 100*/90/50, 50 $50 $1,500 0%
Delta Dental PPOSM, 1500B, 100*/80/50, 25 $25 $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 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%
Delta Dental EPO Plans
Delta Dental EPO,1000, 100*/80/50, 50 $50 $1,000 0%
Delta Dental EPO,1500, 100*/80/50, 50 $50 $1,500 0%
* Deductible waived for Class 1 services
PF means Class 1 does not apply to annual maximum

Questions?

We’re here to help. Contact our Sales and Account service team. You may also find your Membership Accounting contact via access your Employer Dashboard
....