Delta Dental Individual and Family Plan; EHB Certified

56891NC0030005
High
PPO

Delta Dental Individual and Family Plan; EHB Certified is a High PPO plan by Delta Dental of North Carolina.

Locations

Delta Dental Individual and Family Plan; EHB Certified is offered in the following counties.

Plan Overview

This is a plan overview for 2025 version of Delta Dental Individual and Family Plan; EHB Certified 56891NC0030005.
Insurer: Delta Dental of North Carolina
Network Type: PPO
Metal Type: High
HSA Eligible?:
Plan ID: 56891NC0030005

Cost-Sharing Overview

Delta Dental Individual and Family Plan; EHB Certified offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Delta Dental Individual and Family Plan; EHB Certified?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Delta Dental Individual and Family Plan; EHB Certified offers the following features and referral requirements.

Wellness Program:
Disease Program:
Notice Pregnancy:
Referral Specialist:
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Delta Dental Individual and Family Plan; EHB Certified covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Benefits paid at out of network level
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Same benefit level
National Network: Yes

Additional Benefits and Cost-Sharing

Delta Dental Individual and Family Plan; EHB Certified includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Routine Dental Services (Adult)
Covered
No Charge 0.00% Coinsurance after deductibleNo Charge 0.00% Coinsurance after deductible2.0 Visit(s) per Benefit Period
Dental Check-Up for Children
Covered
No Charge 0.00%No Charge 10.00%2.0 Visit(s) per Benefit Period
Basic Dental Care – Child
Covered
No Charge 20.00% Coinsurance after deductibleNo Charge 40.00% Coinsurance after deductible
Orthodontia – Child
Covered
No Charge 50.00%No Charge 50.00%
Major Dental Care – Child
Covered
No Charge 50.00% Coinsurance after deductibleNo Charge 50.00% Coinsurance after deductible
Basic Dental Care – Adult
Covered
No Charge 50.00% Coinsurance after deductibleNo Charge 50.00% Coinsurance after deductible
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Covered
No Charge 50.00%No Charge 50.00%
Accidental Dental
Covered
No Charge 0.00% Coinsurance after deductibleNo Charge 0.00% Coinsurance after deductible

Free Preventive Services

There is no copayment or coinsurance for any of the following Delta Dental Individual and Family Plan; EHB Certified preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Ready to sign up for Delta Dental Individual and Family Plan; EHB Certified?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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