Delta Dental PPO Plus Premier Family Plan High Option · 79597WI0040001
Delta Dental of Wisconsin, Inc. offers this marketplace health insurance plan (Plan ID 79597WI0040001) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.
Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Wisconsin). Submit changes before the deadline to avoid a coverage gap.
Enroll by Dec 15 for Jan 1 starts.
Finalize plan switches before the window closes.
Special Enrollment Periods
You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).
Report the event within 60 days.
Keep documentation handy for Healthcare.gov or your state exchange.
CSR & subsidy reminders
Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.
Enter accurate income to maximize Advanced Premium Tax Credits.
Standard High Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.
Thinking about switching?
Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.
Match provider networks so ongoing care isn’t disrupted.
Confirm prescriptions stay on-formulary or budget for tier changes.
Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.
Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).
Tier 1 in-network20.00% Coinsurance after deductible
Tier 2 in-network30.00% Coinsurance after deductible
Out-of-network30.00% Coinsurance after deductible
nan
Exclusions: Subject to $1,000 annual maximum for PPO providers; $750 annual maximum for non-PPO providers. Age and frequency limits similar to pediatric benchmark plan. Some variation by procedure may exist.
Dental Check-Up for Children
No Charge
Tier 1 in-networkNo Charge
Tier 2 in-networkNo Charge
Out-of-networkNo Charge
nan
Exclusions: Age and frequency limits mirror pediatric benchmark plan.
Major Dental Care - Adult
50.00% Coinsurance after deductible
Tier 1 in-network50.00% Coinsurance after deductible
Tier 2 in-network60.00% Coinsurance after deductible
Out-of-network60.00% Coinsurance after deductible
nan
Exclusions: Subject to $1,000 annual maximum for PPO providers; $750 annual maximum for non-PPO providers. Age and frequency limits similar to pediatric benchmark plan. Some variation by procedure may exist.
Orthodontia - Adult
Coverage details pending
nan
Exclusions: nan
Orthodontia - Child
50.00% Coinsurance after deductible
Tier 1 in-network50.00% Coinsurance after deductible
Tier 2 in-network50.00% Coinsurance after deductible
Out-of-network50.00% Coinsurance after deductible
nan
Exclusions: nan
Routine Dental Services (Adult)
No Charge
Tier 1 in-networkNo Charge
Tier 2 in-network10.00%
Out-of-network10.00%
nan
Exclusions: Subject to $1,000 annual maximum for PPO providers; $750 annual maximum for non-PPO providers. Age and frequency limits similar to pediatric benchmark plan. Some variation by procedure may exist.
Variant attributes
Delta Dental PPO Plus Premier Family Plan High Option · Variant 79597WI0040001-00
Plan identifiers & tier
Issuer-provided metadata for this variant.
Business Year
2025
CSR Variation Type
Standard High Off Exchange Plan
HIOS Product ID
79597WI004
Metal Level
High
Plan ID (Standard Component ID with Variant)
79597WI0040001-00
Plan Marketing Name
Delta Dental PPO Plus Premier Family Plan High Option
Plan Variant Marketing Name
Delta Dental PPO Plus Premier Family Plan High Option
Issuer & service area
Issuer-provided metadata for this variant.
Issuer ID
79597
Issuer Marketplace Marketing Name
Delta Dental of Wisconsin, Inc.
Market Coverage
SHOP (Small Group)
Multiple In Network Tiers
Yes
National Network
Yes
Network ID
WIN002
Out of Country Coverage
No
Out of Service Area Coverage
Yes
Out of Service Area Coverage Description
Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network. Through the Delta Dental Plan Association there is a nationwide network presence.
Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
Dental Only Plan
Yes
First Tier Utilization
55%
Import Date
2024-06-13 01:01:09
Guaranteed Rate
Guaranteed Rate
New/Existing Plan
Existing
Medical EHB Deductible, Combined In/Out of Network, Family Per Group
$150 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person
$50 per person
Medical EHB Deductible, Combined In/Out of Network, Individual
$50
Medical EHB Deductible, In Network (Tier 1), Family Per Group
$150 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person
$50 per person
Medical EHB Deductible, In Network (Tier 1), Individual
$50
Medical EHB Deductible, In Network (Tier 2), Family Per Group
$150 per group
Medical EHB Deductible, In Network (Tier 2), Family Per Person
$50 per person
Medical EHB Deductible, In Network (Tier 2), Individual
$50
Medical EHB Deductible, Out of Network, Family Per Group
$150 per group
Medical EHB Deductible, Out of Network, Family Per Person
$50 per person
Medical EHB Deductible, Out of Network, Individual
$50
Plan Effective Date
2025-01-01
Plan Type
PPO
QHP/Non QHP
Both
Second Tier Utilization
45%
Source Name
HIOS
Plan ID
79597WI0040001
Copay & coinsurance
Pharmacy cost sharing by tier
Drug tier
Pharmacy type
Copay amount
Copay option
Coinsurance rate
Coinsurance option
Mail order
Questions & answers
Frequently asked questions
How do I choose the right ACA plan in Wisconsin?
Delta Dental PPO Plus Premier Family Plan High Option (79597WI0040001) is a High PPO from Delta Dental of Wisconsin, Inc. in Wisconsin for the 2025 coverage year.
Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.
Does Delta Dental PPO Plus Premier Family Plan High Option support telehealth or virtual urgent care?
The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.
Is Delta Dental PPO Plus Premier Family Plan High Option HSA-eligible and does it include dental or vision coverage?
HSA eligibility is not published; check the Summary of Benefits or ask the issuer.
Dental add-ons: Adult, Child.
Vision coverage is not listed for this plan.
Does Delta Dental PPO Plus Premier Family Plan High Option support mail-order prescriptions?
Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.
Is there out-of-country coverage for Delta Dental PPO Plus Premier Family Plan High Option?
No, out-of-country services are not covered for this plan.
Does Delta Dental PPO Plus Premier Family Plan High Option cover care outside the service area?
Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Covered services obtained from any Delta Dental Plan Association member company contracted PPO or Premier provider are considered in network. Through the Delta Dental Plan Association there is a nationwide network presence.
How do I enroll in or manage payments for Delta Dental PPO Plus Premier Family Plan High Option?
Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
