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Delta Dental PPO and PPO plus Premier Frequently Asked Questions

What are the differences between the Delta Dental Premier plus PPO and Delta Dental PPO plans?

Delta Dental PPO plus Premier is a managed fee-for-service plan, while Delta Dental PPO is a preferred provider organization (PPO) plan. The plans are similar in that they allow you to choose any dentist and to change dentists at any time without notifying us. You and your family members can also visit different dentists under the two plans.

The way the plans differ is that under the Delta Dental PPO plan, you receive enhanced benefits and lower out-of-pocket costs when you visit a Delta Dental PPO dentist. For example, under Delta Dental PPO plus Premier, bridges and dentures are covered at 50%; under Delta Dental PPO they are covered at 60% (when visiting a Delta Dental PPO dentist). Also, Delta Dental PPO can give you increased coverage for your dependents and includes implant benefits*. Compare your benefits under each plan.

*There are some limitations to implant benefits, so please check your Evidence of Coverage before obtaining these services.

There are several ways your out-of-pocket costs will be less under the Delta Dental PPO plan:

  • Your payroll deductions will be lower. Under Delta Dental PPO, there is no deduction for employees and a lower deduction for dependents compared to Delta Dental Premier.
  • For some services your benefits will be increased, so your share of the bill will be less.
  • Delta Dental PPO dentists generally charge lower fees.
  • Some additional benefits are available (implant coverage, third cleaning for high-risk patients).

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How can I decide which plan would work better for my family?

After reviewing your benefits under each plan and comparing them to your family's treatment needs, consider what dentist(s) you would visit. To see if your current dentist is a Delta Dental PPO dentist or to find one in your area, go to our dentist directory. Our online directory also provides a map to each office (simply click on the office's street address).

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Are there any special considerations if you are retiring?

If you are retiring and are currently under Delta Dental Premier plus PPO’s Enhanced plan, your dependents will maintain a higher level of benefits under the Delta Dental PPO plan. If you choose to stay with Delta Dental Premier plus PPO, when you become a retiree you will be under the Basic plan, which has a higher deductible and lower benefits for dependents. Also, please note that under Delta Dental PPO, bridges, partial and full dentures are covered at 60% (compared to 50% under Delta Dental Premier plus PPO).

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If I don't select a Delta Dental PPO dentist, should I still consider enrolling in Delta Dental PPO?

It may still be advantageous for you to enroll in Delta Dental PPO, depending on what type of dental services you usually use, because your payroll deduction is lower. For example, if you normally just have regular examinations and teeth cleanings, you would be covered at 80% under Delta Dental PPO when visiting an out-of-network dentist. You may find that your out-of-pocket costs are still less overall because you have no monthly payroll deduction under Delta Dental PPO. Remember, if you go to a non-Delta Dental PPO dentist, you receive the lower level of benefits.

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What is the difference between a Delta Dental dentist and a Delta Dental PPO dentist?

Three out of four dentists in the U.S. are Delta Dental dentists. Delta Dental dentists have an agreement with Delta Dental, which means they agree to abide by Delta Dental's determination of fees, they handle claims paperwork free of charge and they call Delta Dental directly with any inquiries. Because Delta Dental pays these dentists directly, you do not need to pay the entire bill and wait for reimbursement. Instead, you pay only the patient’s portion of the bill.

Delta Dental PPO dentists are a select group of Delta Dental dentists who, in addition to the above conveniences, also charge lower fees. And, when you visit a Delta Dental PPO dentist, you maximize your benefits. There are more than 207,000 Delta Dental PPO dental office locations around the U.S.

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How do I maximize my benefits under the Delta Dental PPO plan?

When you visit a Delta Dental PPO dentist, you receive the highest level of benefits with the lowest out-of-pocket expense. For example, diagnostic and preventive services such as a cleaning are covered at 100% when you visit a Delta Dental PPO dentist or at 80% when you visit a non-Delta Dental PPO dentist. Your deductible is also higher when you go to a non-Delta Dental PPO dentist: $75 per person versus $25 per person for a Delta Dental PPO dentist.

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Why is my payroll deduction so much lower under the Delta Dental PPO plan?

Delta Dental PPO dentists have agreed to charge lower fees (even lower than those of Delta Dental Premier plus PPO dentists). These lower costs can be passed on to employers and their enrollees in the form of lower group rates.

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How do I find a Delta Dental PPO dentist?

Go to our online dentist directory to search for a conveniently located dentist near your home or office. You may also locate a specific dentist by entering his/her last name in the search form.

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When am I eligible for a third cleaning a year?

If you are a high-risk patient, your dentist may recommend a third cleaning each year. High-risk patients are defined as medically compromised (such as diabetes, AIDS, organ transplant, endocarditis), pregnant women and cancer chemotherapy patients. Under the Delta Dental PPO plan, high-risk patients are eligible for a third cleaning in a calendar year. This benefit is not available under Delta Dental PPO plus Premier.

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I'd like my dentist to join Delta Dental PPO. What do I do?

You can recommend your dentist for membership using our online form. Please note that recommendation for Delta Dental PPO membership does not mean that a dentist automatically joins the network.

Recommend your dentist for one of the following networks:

When dentists are recommended, Delta Dental reviews each dentist's background. Then, we send the dentist a packet of information and an invitation to join the network. Ultimately, it is each dentist's decision whether or not to join based on a variety of factors, including accepting the more moderate fees paid under the plan. If you decide to join the Delta Dental PPO plan, do not assume that your dentist will be enrolling and be prepared to switch dentists.

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Do I have to switch to the Delta Dental PPO plan?

No, you may continue with your State-sponsored plan as long as you are eligible. You do not need to do anything to continue your current benefit plan.

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What benefits are offered to my dependents?

Under the Delta Dental PPO plan, your spouse and children have increased benefits. Here is a comparison with the Delta Dental PPO plus Premier plan:

Coverage under Delta Dental PPO Coverage under Delta Dental PPO plus Premier Basic Coverage under Delta Dental PPO plus Premier Enhanced
Employees and Dependents Employees Dependents Employees and Dependents
Extractions, root canal, sealants 90% 90% 80% 90%
Crowns 80% 80% 50% 80%
Bridges and dentures (prosthodontics) 60% 50% 50% 50%
Annual maximum $2,000 $2,000 $1,000 $2,000
Orthodontic lifetime maximum for child $1,500 $1,000 $1,000 $1,000

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When can I change my dental plan?

You can change your plan during your regular State-sponsored open enrollment period in the fall. You'll have the opportunity to switch plans again at next year's open enrollment.

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Can I change plans if my child is in the middle of orthodontic treatment?

If your child is currently undergoing orthodontic treatment and you are in the Delta Dental PPO plus Premier plan, you can still switch to Delta Dental PPO without any loss of benefits. And, if the dentist is a Delta Dental PPO dentist, you may be eligible for an additional orthodontic benefit of up to $500 for work in progress. The actual payment will vary, based on such factors as the overall cost of treatment and the number of months your child would continue to be in active treatment.

If you are enrolled in one of the State-sponsored prepaid dental plans, you can also change plans, but doing so may increase your out-of-pocket expenses. The reason is that the fee agreement that was negotiated between the prepaid plan and your dentist would no longer be in effect, and the dental office can increase the charges for the remainder of the treatment.

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What if I have additional, specific questions?

You can contact Delta Dental's Customer Service department at 800-225-3368 or you can submit an inquiry online.

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