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 Insider Update - Tips to help make selling simple

Insider Update

Tips to help make selling simple

PPO and Premier: How Delta Dental’s dual network works

When covered under a Delta Dental PPO™ plan, members have access to two Delta Dental networks that make up the largest dental network in the country: Delta Dental PPO and Delta Dental Premier®. But what are these networks, and how can understanding the difference help your members make informed decisions? Let’s take a closer look.

What are the Delta Dental PPO and Delta Dental Premier networks?

Delta Dental PPO and Delta Dental Premier are two dentist networks accessible by members with Delta Dental PPO plans.

The Delta Dental PPO network is a large, high-quality and reliable network of dentists for Delta Dental’s PPO-type plan members. Members don’t need to worry about carrying paper ID cards or submitting claims, since we work with dentists directly to manage identification and claims.

The Delta Dental Premier network offers the same ease and quality as the Delta Dental PPO network but with more limited out-of-pocket savings.

Together, Delta Dental PPO and Delta Dental Premier make up the largest network of dentists in the nation, according to Zelis Network360.

The main difference between the networks lies in how much plan members save.

How PPO plan members can save the most

By visiting a dentist in the Delta Dental PPO network, your PPO plan members pay less out of pocket and make their plan maximum go farther.

But your members don’t have to sacrifice plan savings if they can’t find a Delta Dental PPO dentist who fits their needs. The Delta Dental Premier network works as a safety net — members who go to dentists in the Premier network can expect the same advantages of a high-quality network and easy access, but they pay a bit more out of pocket.

Think of the three options — PPO, Premier and non–Delta Dental dentists — like a tier system. Your members typically save the most by visiting a Delta Dental PPO dentist, a little less at a Premier dentist and the least at a non–Delta Dental dentist.

This is because Delta Dental PPO and Premier dentists agree to charge set fees, as part of their contract with Delta Dental. They can’t charge PPO members more than these fees. Premier fees are typically higher than Delta Dental PPO fees, but PPO members still enjoy cost protection at Premier dentists. Non–Delta Dental dentists can set their prices wherever they want.

Low fees reduce your members’ out-of-pocket expenses and let their plan dollars go further.

Your plan configuration can help encourage PPO utilization

To encourage in-network visits long term for group plans, work with your Delta Dental Account Executive to build incentives into plan designs that encourage visiting in-network dentists. Depending on their state, your group clients may have the following options:

  • Reward employees who stay in network with a higher maximum and lower (or no) deductible for in-network visits.
  • Cover services at a higher benefit level for in-network care. For example, a plan with a benefit network differential might cover diagnostic and preventive services at 100% at PPO dentists, 90% at Premier dentists and 80% at non–Delta Dental dentists. This makes it clear to members that PPO dentists offers the greatest savings.
  • Lower your out-of-network reimbursement to encourage PPO and Premier network usage and potentially lower your plan’s cost.

How reimbursement differs by network

The amount your plan bases its payment on is the reimbursement, also known as the maximum plan allowance. This is separate from the percentage at which certain services are covered.

Under a Delta Dental PPO plan, PPO dentists are reimbursed at PPO fees and Premier dentists are reimbursed at either Premier or PPO fees. How Premier dentists are reimbursed under your PPO plan is up to you or the plan’s benefits administrator, but there are advantages to each of the two options:

  • When you choose to reimburse Premier dentists at Premier fees, members enjoy the lowest out-of-pocket costs, but the plan pays more and may cost more overall.
  • If you choose to reimburse Premier dentists at PPO fees, members face higher out-of-pocket expenses at Premier dentists, but the plan may cost less overall. This option also creates a greater incentive for members to visit a PPO dentist.

Network transparency empowers your members to save money

Many insurers have set their networks up similarly to Delta Dental’s, with multiple networks that cater to their PPO plan members. What sets Delta Dental apart is that we make the distinctions between networks clear and easy to navigate. This allows members choose the best option for their needs and budget.

Your members can check a dentist’s network by using the Find a Dentist tool. Members just enter their own location and choose their preferred network from the Select a network drop-down menu. Each dentist’s directory listing indicates which networks the dentist participates in.

Help your members understand the PPO and Premier networks

If your members or group clients are interested in learning more about the differences between the Delta Dental PPO and Delta Dental Premier networks, we offer materials that can help:

With Delta Dental’s dual network, your members and group clients can make informed choices about their care and costs, without sacrificing quality.