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Group plan documents Oregon

Quickly and easily download everything you and your employees need for enrolling in a Delta Dental plan, filing claims and administering benefits. Employers should log into their Employers Dashboard to access their plan documents or contact their agent or sales for help.

View benefit summaries below:

2023 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 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 2000 Incentive (70-100) 0 $0 $2,000 1st year - 30%
2nd year - 20%
3rd year - 10%
4th year - 0%
Delta Dental Premier 2500 100/80/50 50 $50 $2,500 0%
Delta Dental Premier Shining Smiles $50 N/A 10%
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, 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 50 $50 $1,500 0%
Delta Dental PPOSM 1500B 100/80/50 50 $50 $1,500 0%
Delta Dental PPOSM 2000A 100/90/50 25 $25 $2,000 0%
Delta Dental PPOSM 2000B 100/80/50 50 $50 $2,000 0%
Delta Dental PPOSM 2500A 100/90/50 50 $50 $2,500 0%
PPO Plus 1 $25 $1,100 0%
PPO Plus 2 $25 $1,600 0%
PPO Plus 3 $25 $2,100 0%
PPO Plus 4 $25 $2,600 0%
PPO Plus 5 $25 $3,000 0%
PPO MAC Plans
Delta Dental PPO MAC 1000 75/60/50 50 $50 $1,000 0%
Delta Dental PPO MAC 1500 100/60/50 50 $50 $1,500 0%
PPO Preventive First Plans
Delta Dental PPO PF 1000 100/80/50 50 $50 $1,000 0%
Delta Dental PPO PF 1000A 100/90/50 50 $50 $1,000 0%
Delta Dental PPO PF 1000B 100/80/50 50 $50 $1,000 0%
Delta Dental PPO PF 1500 100/80/50 50 $50 $1,500 0%
Delta Dental PPO PF 1500A 100/90/50 50 $50 $1,500  0%
Delta Dental PPO PF 1500B 100/80/50 50 $50 $1,500 0%
PPO Voluntary Plans
Delta Dental PPOSM Voluntary 1000 100/80/50 50 $50 $1,000 0%
Delta Dental PPOSM Voluntary 1000 100/90/50 50 $50 $1,000 0%
Delta Dental PPOSM Voluntary 1500 100/80/50 50 $50 $1,500 0%
Delta Dental PPOSM Voluntary 1500 100/90/50 50 $50 $1,500 0%
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%
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 1J-JK $0 No annual max $15
Direct Option 3J-JK $0 $15
Direct Option 5J-JK $0 $25
Direct Option 7J-JK $0 $30
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 VDO1J and VDO1JK $0 No annual max $15
Voluntary Direct Option VDO2J and VDO2JK $0 $25
Voluntary Direct Option 3J-JK-V $0 $15
Voluntary Direct Option 5J-JK-V $0 $25
Voluntary Direct Option 7J-JK-V $0 $30

2023 Oregon Large Group dental plans (50+)

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

Premier plans

PPO plans

Voluntary plans

Direct Option plans

(with Willamette Dental Group)

Voluntary Direct Option plans

(with Willamette Dental Group)

Ortho plans

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 VDO1J and VDO1JK No deductible $350 for one child; $700 for two or more children Covered at 100%
Voluntary Direct Option VDO2J and VDO2JK 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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