Your Dental Program

Delta Dental is pleased to provide dental benefits for employees of Enable Midstream Partners. This website provides a brief description of the most important features of your Delta Dental of Oklahoma dental benefits program. For more specific questions regarding your benefits, please contact our friendly Customer Service Department at 800-522-0188 (Toll Free) or 405-607-2100 (OKC Metro).

Delta Dental’s PPO – Plus Premier program includes both the Delta Dental PPO and Premier networks under one program, maximizing network savings while increasing network access.

One program with access to both the PPO and Premier network
Provider reimbursements based on network utilized
Additional out-of-pocket savings when utilizing a PPO network provider
No balance-billing for either network
Pre-existing conditions covered
Claim filing by participating dentist
Individual Retiree Conversion option available

Delta Dental PPO – Plus Premier

Click Here for a Detailed Benefit Summary

BENEFIT PLAN		Delta Dental PPO	Delta Dental Premier	Out of Network

Diagnostic & Preventive-Class I		100%	100%	100%
Basic Restorative-Class II		80%	80%	80%
Major Restorative-Class III		60%	60%	60%
Orthodontics-Class IV (eligible Dependent Children Only)		50%	50%	50%

Deductible:		$50 Per Person $100 Per Family Per Benefit Year	$50 Per Person $100 Per Family Per Benefit Year	$50 Per Person $100 Per Family Per Benefit Year
Applies to:		Classes II, III & IV Only	Classes II, III & IV Only	Classes II, III & IV Only


Maximum Benefit Payment:	$1,800 Per Person Per Benefit Year for Class I, Class II, and Class III Services Combined. $1,500 Lifetime Maximum Benefit Payment Per Eligible Dependent Child for Class IV Services.

Note:

Deductibles do not apply to Class I or Class IV services.

Benefits payable by the Plan for covered oral evaluations (examinations), procedure codes D0120-D0180, and routine prophylaxis (cleaning), procedure codes D1110 and D1120, will not reduce the maximum benefit payment per person during the benefit year for combined Class I, Class II, and Class III covered dental services.

The information contained herein is not intended as a Summary Plan Description, nor is it designed to serve as Evidence of Coverage for this program. Benefits for some covered services may be subject to waiting periods or limitations such as age of patient, frequency of procedure, etc., or excluded in some instances. If you have specific questions about your dental benefits, consult your Summary Plan Description, or call 405-607-2100 (OKC Metro) or 800-522-0188 (Toll Free). You may write Delta Dental of Oklahoma at P.O. Box 54709, Oklahoma City, Oklahoma 73154-1709.