Keeping your smile happy and healthy is easier than ever with the Delta Dental PPO, part of the AARP® Dental Insurance Plan, administered by Delta Dental Insurance Company. Designed exclusively for AARP members, our PPO options provide you with the peace of mind that comes from having a wide range of coverage and the freedom to visit any dentist you want. So you can keep your current dentist, have the combination of benefits you need, and enjoy cost savings to keep you smiling. Here are a few benefits you'll enjoy while protecting your smile:
The Delta Dental PPO allows you to choose from two PPO options with two different benefit levels.
Plan A provides benefits for most dental procedures at a moderate premium.
Plan B offers a lower monthly premium than Plan A, with slightly reduced benefits for some preventive and basic services.
The dental procedures covered, waiting periods, and most other aspects of the PPO plans are identical. Both options also include:
¹See limitations and exclusions. Annual deductibles, copayments, and maximums apply.
²Report by Ignition Group, 2010.
Delta Dental PPO
|PPO Plan A||PPO Plan B|
|Delta Dental Pays||Member Pays||Delta Dental Pays||Member Pays|
|Benefits in Year 1|
Diagnostic and preventive (includes exams, X-rays, and cleanings)
NOTE: In Plan A, no deductible is required for diagnostic or preventive services.
In Plan B, Calendar Year deductible applies.
|Periodontal maintenance cleanings (gum cleanings)||80%||20%||50%||50%|
|Restorations (including tooth-colored fillings)||50%||50%||50%||50%|
|Endodontics (root canals)||50%||50%||50%||50%|
|Additional Benefits after 1 Year of Continuous Enrollment|
|Periodontics (gum disease treatment)||50%||50%||50%||50%|
|Crown and cast restorations||50%||50%||50%||50%|
|Dental implant services||50%||50%||50%||50%|
|Temporomandibular Joint Dysfunction (TMJ)||50%||50%||50%||50%|
|Additional Benefits with Annual Rate Payment|
|Dental accident ($1,000 lifetime maximum)||100%||0%||Not a benefit
in Plan B
|Deductibles and Maximums per Enrollee|
|Calendar Year deductible||$50||$100|
|Calendar Year maximum benefit||$1,500||$1,000|
|Temporomandibular Joint Dysfunction (TMJ) — lifetime maximum||$300||$300|
|Bold items indicate the differences between Plan A and Plan B.|
This chart provides a summary of the benefits available with the Delta Dental PPO options. Please view the Certificate of Coverage/Benefit Handbook for a complete description. Also, you can find more information in the Plan's Limitations & Exclusions.
*Delta Dental's payment under this plan is limited to the applicable percentage of the lesser of: a) your dentist's actual charges; or b) the Delta Dental PPO Maximum Plan Allowance (the highest amount that Delta Dental will pay to a Delta Dental PPO dentist where you received the services). You will be required to pay the balance of the dentist's fee not paid by Delta Dental. When receiving treatment from a Delta Dental Premier (Premier) dentist, you may be required to pay any cost above the Delta Dental PPO Maximum Plan Allowance, up to your dentist's Premier Maximum Plan Allowance. When receiving treatment from a non-Delta Dental dentist, there is no limit regarding their fees.
Delta Dental PPO (PPO) dentists: While you have the freedom to visit any licensed dentist, you can maximize your savings when you visit a Delta Dental PPO network dentist because they've agreed to provide covered procedures for reduced, pre-negotiated fees.
Delta Dental Premier® (Premier) dentists: Their pre-negotiated fees are usually higher than PPO dentists,¹ and you'll be responsible for paying the difference between the two fees. However, you won't be billed above the Premier dentist's fees, so you can still save more compared to a non-Delta Dental dentist.
Non-Delta Dental dentists: These dentists don't accept pre-negotiated fees and may charge their full cost of treatment. Since they may or may not handle claims paperwork, you may have to pay up front and submit a claim to Delta Dental for reimbursement.
The following chart illustrates¹ how a claim might be paid for a simple restoration at the three different types of dentists.
|Example of Simple Restoration. Delta Dental Pays 50% of PPO Allowed Fee.|
|Dentist Type||Dentist's Normal Fee||Fee Allowed by Delta Dental²||Delta Dental Pays||Member Pays³|
|1) Delta Dental PPO||$100||$80||$40||$40|
|2) Delta Dental Premier||$100||$90||$40||$50|
|3) Non-Delta Dental||$100||$100||$40||$60|
To maximize your savings when selecting a dentist, be sure to ask whether they are a Delta Dental PPO or Premier dentist. See all dentists in your area.
¹The dollar amounts in this example are for illustrative purposes only. Charges may vary depending on the services provided and the dentist seen. See the "HOW CLAIMS ARE PAID" section of your Certificate of Coverage for more details.
²Fee Allowed by Delta Dental is the PPO Maximum Allowance for PPO dentists, the Premier Maximum Allowance for Premier dentists, or the full amount billed for non-Delta Dental dentists.
³You are responsible for any amount over the plan Calendar Year maximum benefit and any non-covered service.