Memorial Hermann offers two dental plans, so you can choose the plan that’s best for you: the Delta Dental Preferred Provider Organization (PPO) and the Deltacare USA Health Maintenance Organization (HMO).
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.
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.
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, which is also available on allHR.
Choose What’s Right for You!
While our dental plans cover the same services, they differ in a few key ways.
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 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% |
|
|
Basic Services: Fillings and Simple Tooth Extractions |
20% |
|
|
Endodontic (root canals) – Covered Under Basic Services |
20% |
|
|
Periodontics (gum treatment) – Covered Under Basic Services |
20% |
|
|
Oral Surgery – Covered Under Basic Services |
20% |
|
|
Major Services: Crowns, Inlays, Onlays and Cast Restorations, Bridges and Dentures |
50% |
|
|
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 |
|
|
Enhanced Cleaning Benefits for Pregnancy |
Includes oral evaluation and cleaning |
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).
The premiums shown here are for FY24. For a look at FY25 premiums, refer to FY25 Premiums. This page will be updated on July 1, 2024 with FY25 information.
|
Delta Dental PPO |
DeltaCare USA HMO |
|||
|---|---|---|---|---|
|
Coverage |
FY24 Annual |
FY24 Biweekly |
FY24 Annual |
FY24 Biweekly |
|
Employee |
$392.76 |
$15.11 |
$151.08 |
$5.81 |
|
Employee + Spouse |
$766.08 |
$29.47 |
$346.08 |
$13.31 |
|
Employee + Child(ren) |
$923.04 |
$35.50 |
$316.08 |
$12.19 |
|
Employee + Family |
$1,433.64 |
$55.14 |
$447.48 |
$17.21 |