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Help Enrollees Use Delta Dental PPOSM

With a Delta Dental preferred provider organization (PPO) plan, network dentists accept a contracted fee as payment in full instead of their usual fee. While enrollees can visit any licensed dentist, they’ll usually save the most with a Delta Dental PPO network dentist. Patients pay a percentage of the contracted fee, which is called coinsurance, and we pay the rest. The percentage varies with each category of service, which is typically broken down into sets of procedures that are diagnostic and preventive, basic or major.

Enrollees pay a dollar amount, called a deductible, before the plan begins paying benefits. The plan will pay its share of the coinsurance up to the annual maximum for dental care for an individual or family (depending on the plan) during the defined plan year.

Delta Dental PPO plan designs

We offer two base plan options that differ only in how non-Delta Dental PPO dentist reimbursement is calculated: Delta Dental PPO and Delta Dental PPO plus Premier 43 KB. Either option offers savings and access to both of our great networks.

If your group has selected the Delta Dental PPO fee basis, all claims are calculated at the PPO contract allowance (more balance billing out of network). Claims might look similar to this:*

Dental Network

Delta Dental PPO

Delta Dental Premier ®

Non-Delta Dental Dentist

Dentist's charge for a crown

$1,200

$1,200

$1,200

Plan allowance

$700

$900

N/A

Coinsurance

60%

60%

60%

Plan pays

$420

$420

$420

Enrollee pays

$280
($700-$420)

$480
($900-$420)

$780
($1,200-$420)

If your group has selected the Delta Dental PPO plus Premier fee basis, claims for PPO dentists are calculated using the PPO contract allowance; claims for Delta Dental Premier and non-Delta Dental dentists are calculated using the Premier (slightly higher) contract allowance (less balance billing out of network). Claims might look similar to this:*

Dental Network

Delta Dental PPO

Delta Dental Premier

Non-Delta Dental Dentist

Dentist's charge for a crown

$1,200

$1,200

$1,200

Plan allowance

$700

$900

N/A

Coinsurance

60%

60%

60%

Plan pays

$420

$540

$540

Enrollee pays

$280
($700-$420)

$360
($900-$540)

$660
($1,200-$540)

* Hypothetical example for illustrative purposes assumes that the plan’s deductible has been previously satisfied, the annual maximum has not been reached and the benefit levels for in- and out-of-network treatment are the same.

Stay in network

Stay in network

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PPO enrollees are free to visit any licensed dentist; however, by encouraging them to stay in network both groups and enrollees have more opportunities to save. With nearly 80% of practicing dentists in our networks, there’s a good chance your enrollees are already visiting a Delta Dental provider.* And with helpful tools to locate participating providers, it’s easy to encourage enrollees to visit a network dentist.


* Delta Dental Unique Dentist Penetration Report, September 2016.


Visit our Benefits Administrator YouTube Channel

More network access

More network access

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What separates Delta Dental PPO from other carriers is access. While enrollees can access the Delta Dental PPO network for the most savings, they can also use Delta Dental Premier, a network that can offer moderate savings for enrollees that choose to visit a non-PPO network dentist.


Visit our Benefits Administrator YouTube Channel

Web features for Delta Dental PPO enrollees

It’s easy for your PPO enrollees to maximize their plan with Online Services. And it takes just a few minutes to register. Most features can be accessed from a mobile device. Share this information with enrollees to help them learn more.

Find a dentist

Enrollees can find a network dentist by location or specialty. (They can also Find a Dentist without logging in to Online Services, but they must know their network.)

Check benefits, eligibility and claims

Viewing benefits and eligibility, including covered services, remaining maximums and deductibles, is simple with Online Services. Enrollees can also access claims statements.

View or print ID cards

ID cards can be printed, or enrollees can pull them up on a mobile device to show at the dentist’s office.

Get cost estimates

Delta Dental’s Cost Estimator can help PPO enrollees research estimated costs for most common dental visits by speciality and location.

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