Dental Coverage

Oral health is closely tied to our overall well-being. Taking care of our teeth and gums can help prevent diseases, reduce the risk of chronic conditions and even support our mental health.

Memorial Hermann offers two dental plans, so you can choose the options that’s best for you:

  • The Delta Dental Preferred Provider Organization (PPO)
  • The Deltacare USA Health Maintenance Organization (HMO) 

What’s the Same

Both plans are offered through Delta Dental and include $0 in-network preventive care (two routine cleanings per year; one every six months), as well as coverage for basic services like fillings, orthodontic care, oral surgery and more. 

What’s Different

The Delta Dental PPO allows you the freedom to visit any licensed dentist, but you will receive greater benefits when you use a Delta Dental PPO network dentist. This plan also covers orthodontia care for dependents up to age 19 only.

After you meet your deductible ($50/individual, $150/family), the plan will pay up to the annual maximum of $1,500 for care per year. For more coverage details, see the Plan Comparison below.  Note: Any eligible family member can contribute to the family deductible, but at least one person must meet the individual deductible before the family deductible requirements are met.

After you meet the deductible, you pay the applicable coinsurance, as shown in the Plan Comparison below. We recommend that you request a pre-determination from Delta Dental to determine the cost of your procedures. This process may take two to three weeks. You can also use the Fee Finder tool on www.denltadentalins.com.

The DeltaCare USA HMO requires you to designate a primary care dentist and encourages regular visits with lower copays. Out-of-network care is not covered, except in certain emergency situations. However, all covered dependents are eligible for orthodontia care, regardless of age. 

To see what you’ll pay for care, refer to this DHMO fee schedule.

Choose What’s Right for You!

While our dental plans cover the same services, they differ in a few key ways. 

  • The Delta Dental PPO has higher premiums, and gives you more flexibility to choose any provider – though you will pay less out of pocket when you visit in-network providers. In addition, this plan covers orthodontia care for dependents up to age 19. 
  • The DeltaCare USA HMO costs less in premiums, and only offers in-network care. So, you must see an approved provider. In addition, this plan covers orthodontia care for anyone enrolled, including adults.  

What is your priority: Keeping your costs lower or having more provider options? Do you need orthodontia care for someone over the age of 19?

Delta Dental Contact Information

Visit deltadentalins.com and download the Delta Dental mobile app to easily access your coverage details and find in-network providers.

If you have any questions about your coverage, claims or in-network providers or require an additional ID card, call:

  • Delta Dental PPO: 800.521.2651

(Group #: 07410)

  • DeltaCare USA HMO: 800.422.4234

(Group #: 76144)

Delta Dental PPO1

DeltaCare USA HMO2

In-Network and Out-of-Network

In-Network Only

Annual Deductible

$50 per individual/ $150 per family (deductible is waived for diagnostic and preventive services)

Not applicable

Benefit Maximum

$1,500 per person (diagnostic and preventive services don’t count toward maximum)

Not applicable

Orthodontic Deductible

$50 lifetime deductible  per person

Not applicable

Diagnostic and Preventive Services: Exams, Cleaning, X-Rays

0%

Per DHMO fee schedule

Basic Services: Fillings and Simple Tooth Extractions

20%

Per DHMO fee schedule

Endodontic (root canals) – Covered Under Basic Services

20%

Per DHMO fee schedule

Periodontics (gum treatment) – Covered Under Basic Services

20%

Per DHMO fee schedule

Oral Surgery – Covered Under Basic Services

20%

Per DHMO fee schedule

Major Services: Crowns, Inlays, Onlays and Cast Restorations, Bridges and Dentures

50%

Per DHMO fee schedule

Orthodontic Benefits

Dependent children to age 19: 50%

Dependent children up to the age of 26 and adults (employee and spouse): per DHMO fee schedule

Orthodontic Maximums

Plan pays: $1,500 lifetime

Per DHMO fee schedule

Enhanced Cleaning Benefits for Pregnancy

Includes oral evaluation and cleaning

Per DHMO fee schedule
1 Includes Delta Dental PPO dentists and non-Delta Dental dentists.
2 Contract specialists may differ.

Note: Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fee. You are responsible for any charges above allowed amounts when using a non-Delta Dental dentist.

The amount you pay for dental coverage is based on the plan you choose and who you choose to cover. It is deducted from your paychecks before taxes are calculated (i.e., on a pre-tax basis).

Delta Dental PPO

DeltaCare USA HMO

Coverage

FY25 Annual

FY25 Biweekly

FY25 Annual

FY25 Biweekly

Employee

$398.64

$15.33

$158.64

$6.10

Employee + Spouse

$777.60

$29.91

$363.36

$13.98

Employee + Child(ren)

$936.84

$36.03

$332.64

$12.79

Employee + Family

$1,455.12

$55.97

$469.80

$18.07

In many cases, your dentist will submit claims on your behalf. If your dentist does not submit claims, then you can submit the claims directly to Delta Dental by:

  1. Downloading a claim form from the website.
  2. Completing the form and attaching a copy of the dentist’s statement of treatment, including the dentist’s name, phone number and a description of each service performed.
  3. Making a copy for your records.
  4. Mailing the original claim and statement of treatment to the address provided on the claim form. Claims are generally processed within two (2) weeks unless additional information is required from you or the dentist.

If you have a dental emergency, you should:

  • Obtain routine or urgent care from any licensed dentist during normal office hours.
  • Preauthorization is not required for emergency treatment after normal office hours from a licensed dentist.
  • Out-of-pocket costs are likely to be lower if you receive emergency care from a dentist who is in your network.

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