Dental
The Port provides the employees a choice of two plans, Delta (DPO) and Consumer Dental Plan. The Port contributes 100% of premium cost for active and retired employees and for their depend.

• About DPO USA
• DPO USA is easy to use
• Benefits and covered services
• Services not covered

The Delta Preferred Option USA (DPO USA) Program allows you to:

• Save on out-of-pocket expense when you visit a DPO network dental office
• Visit any dentist of your choice - select a different dentist for each member of your family
• Change dentist at any time without preapproval
• Go to a dentist specialist of your choice without preapproval
• Receive dental care anywhere in the world

Under the DPO USA program, you may visit any licensed dentist you wish. However, you receive the maximum benefits under the program when you choose a DPO network dental office. There are also advantages to choosing a delta dentist. More than 100,000 dentists nation wide — two out of every three dentists — participate with the Delta Dental Plans. Remember, you get your best benefits when you visit an in-network dentist:

In-Network — DPO Dentist

• Your out-of-pocket expense will probably be less because DPO dentists have agreed to charge DPO patients reduced fees
  
• Claim forms will be completed and submitted for you at no charge
  
• You may be charged only the patient share* at any time of treatment, not Delta’s portion
  

Out-Of-Network — Non-DPO Delta Dentist

• You will be charged no more than the fees approved by Delta
  
• Claim forms will be completed and submitted for you at no charge
  
• You may be charged only the patient share* the time of treatment, not Delta’s portion
  

Out-Of-Network — Non-Delta Dentist

• You will be responsible for dentist’s fees, which may be higher than those approved by Delta
  
• You may have to complete and submit your own claim form or pay a service fee
  
• You may have to pay entire amount in advance and wait for reimbursement
  

*”Patient share” is the co-payment, any deductible and any amount over the annual maximum. Some services may not be covered; please refer to your Evidence of Coverage. Some examples of services not covered are cosmetic dentistry, experimental procedures and services to correct congenital malformations.

DPO USA is easy to use
DPO USA is Delta’s national preferred provider program. The program provides maximum benefits when you visit a DPO dentist. DPO dentists are Delta dentists who have agreed to charge DPO patients reduced fees; you receive the in-network benefit when visiting a DPO network dental office.

To use your DPO USA program, just call the dental office of your choice and make an appointment. During your first appointment, give your dentist your group number, which is at the top of this page, and the primary enrollee’s social security number.

Click here for a complete list of DPO dentists in your area or call (800) 427-3237.

Benefits and Covered Services

When Treatment is Provided by...		An In-Network Dentist**		An Out-of-Network Dentist
Who's Covered		Primary enrollee and spouse as well as dependent children to age 19 and full-time students to age 25		Primary enrollee and spouse as well as dependent children to age 19 and full-time students to age 25

Services that are Not Covered
Although your program covers many of the most commonly needed services, some services are not covered. If you are unsure whether a particular procedure is covered, or how much of it is paid for by your program, check with delta before proceeding.

The program does not cover the following:

• Services for injuries or conditions covered under Workers’ Compensation or Employer’s Liability Laws
• Cosmetic surgery or dentistry or services to correct congenital malformation
• Experimental procedures
• Therapeutic drugs, premedication or pain relievers
• Hospital costs or extra charges for hospital treatment
• Anesthesia (except for general anesthesia for oral surgery)
• Extra-oral grafts, implants, and implant removal
• Treatment related to the temporomandibular joint (TMJ)