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Delta Dental PPO™
All about your plan
Your preferred provider organization (PPO) dental plan is a fee-for-service plan. The plan focuses on prevention, early diagnosis and treatment to help you stay healthy. Preventive care — like routine cleanings and exams — is covered at a low cost.
You have a wide array of covered services with no waiting period, and there are no claim forms to fill out when you visit a Delta Dental network dentist. You have two dentist networks available under this plan: Delta Dental PPO and Delta Dental Premier®.
Stay flexible and keep your options open
Choosing a PPO or Premier dentist saves money because you only pay a percentage. Covered services are paid based on a percentage of the dentist’s fee. For example, if fillings are covered at 95%, you pay the remaining 5% of the cost. (You may be responsible for a deductible, as well as charges for non-covered services and amounts over the annual maximum. Visiting an out-of-network dentist may lead to higher costs if the dentist’s fee is more than your plan’s maximum allowance for the procedure.)
Choose any dentist
Visit any licensed dentist, anywhere. Save the most by visiting a dentist from the PPO network. These dentists agree to reduced fees, and they won’t charge you more than your expected share of the bill. They also complete your claim forms and can advise you on questions about your share of the bill. It’s easy to locate a dentist near you.
You and family members covered under your plan don’t have to visit the same dentist.
Choosing a Dentist
The chart below shows an example of savings you may expect when visiting a Delta Dental PPO network dentist or a Delta Dental Premier dentist as compared to the cost of treatment from a non-Delta Dental, non-contracted dentist. These are hypothetical numbers for illustrative purposes only and assume that no maximums or deductibles apply.
Example |
Delta Dental PPO™ |
Delta Dental Premier® Dentist |
Non-Delta Dental Dentist* |
|---|---|---|---|
| Dentist's charge for a crown | $1,000 | $1,000 | $1,000 |
| Contract allowance (amount on which Delta Dental bases its payment) |
$640 | $800 | $900 |
| Coinsurance (% of contract allowance Delta Dental will pay) |
90% | 90% | 60% |
| Delta Dental's share | $576 | $720 | $540 |
| Member's share | $64 | $80 | $360 |
| Balance billing (any amount over the contract allowance that member is paying) |
$0 | $0 | $100 |
Resources
*Non-Delta Dental, non-contracted dentists (out-of-network dentists) are paid based on usual and customary charges; therefore, you may pay higher out-of-pocket costs when using a non-network dentist.