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Office of the Comptroller of the Currency
Compare your options PPO vs DeltaCare
Office of the Comptroller of the Currency
Compare your options
Compare your options with Delta Dental
As an employee, the OCC Dental Insurance Program offers you the choice of two quality dental options — the PPO option called Delta Dental PPO™ and the dental HMO (DHMO) option known DeltaCare® USA. Each option is structured differently.
PPO Plan
The PPO plan has a network of preferred providers and you can visit any licensed dentist for treatment. The plan provides for both in and out-of-network benefits; however, you will usually receive the greatest benefit when you visit a participating in-network dentist. If you are covered by other dental insurance, coordination of benefits is applicable. One very important requirement is that any dental coverage you may have under either of the federal benefit programs (Federal Employees Health Benefits [FEHB] or Federal Employees Dental and Vision Insurance Program [FEDVIP]) is the primary payer to any benefits payable under this program.
DeltaCare USA plan
The DeltaCare USA (DHMO) plan, in most states, operates through a network of participating dentists who manage all of your dental care. You will be required to select a primary care dentist or one may be assigned to you.¹ You pay a fixed copayment for services, and except for emergencies, there is generally no coverage for out-of-network benefits. If you are covered by other dental insurance, coordination of benefits does not apply.
Plan comparison
| Plan Features | PPO In-Network | PPO Out-of-Network ** | DeltaCare USA (DHMO) **** | ||
|---|---|---|---|---|---|
| Plan pays | You pay | Plan pays | You pay | ||
| Class I – Diagnostic and Preventive (exams, x-rays, cleanings) |
100% | 0% | 100% | 0% | No cost |
| Class II – Basic Restorative (fillings, root canals, simple extractions) |
80%* | 20%* | 80%* | 20%* | Copayments range from $0 - $380 |
| Class III – Major Restorative Care (crowns, wisdom teeth extractions, partials, dentures, implants)*** |
60%* | 40%* | 60%* | 40%* | Copayments range from $10 - $415 Optional treatment: limited to implant/abutment supported crowns and dentures |
| Class IV – Orthodontia | 60% | 40% | 60% | 40% | Copayments range from $1,150 - $2,100 |
| Authorization for specialty care treatment | Preauthorization is not required | Preauthorization is not required | Your DeltaCare USA (DHMO) dentist will coordinate authorization for specialty care treatment† | ||
| Annual Deductible | $50 per person $150 per family |
$50 per person $150 per family |
No annual deductible | ||
| Annual Maximum (Class I, II and III services) |
$2,500 | $2,500 | No annual maximum | ||
| Orthodontic Lifetime Maximum | $2,000 for adults and children | $2,000 for adults and children | No lifetime orthodontic maximum | ||
| Claims | Delta Dental network dentists file claim forms and accept payment directly from Delta Dental | Non-Delta Dental dentists may require payment upfront and may require you to file your own claim for reimbursement | No claim forms Pay the listed copayment for covered services at the time of your visit |
||
Plan comparison
Class I – Diagnostic and Preventive
(exams, x-rays, cleanings)
PPO In-Network
- Plan pays: 100%
- You pay: 0%
PPO Out-of-Network **
- Plan pays: 100%
- You pay: 0%
DeltaCare USA (DHMO) ****
No cost
Class II – Basic Restorative
(fillings, root canals, simple extractions)
PPO In-Network
- Plan pays: 80%*
- You pay: 20%*
PPO Out-of-Network **
- Plan pays: 80%*
- You pay: 20%*
DeltaCare USA (DHMO) ****
Copayments range from $0 - $380
Class III – Major Restorative Care
(crowns, wisdom teeth extractions, partials, dentures, implants)***
PPO In-Network
- Plan pays: 60%*
- You pay: 40%*
PPO Out-of-Network **
- Plan pays: 60%*
- You pay: 40%*
DeltaCare USA (DHMO) ****
Copayments range from $12 - $415
Optional treatment: limited to implant/abutment supported crowns and dentures
Class IV – Orthodontia
PPO In-Network
- Plan pays: 60%
- You pay: 40%
PPO Out-of-Network **
- Plan pays: 60%
- You pay: 40%
DeltaCare USA (DHMO) ****
Copayments range from $1,150 - $2,100
Authorization for specialty care treatment
PPO In-Network
Preauthorization is not required
PPO Out-of-Network **
Preauthorization is not required
DeltaCare USA (DHMO) ****
Your DeltaCare USA (DHMO) dentist will coordinate authorization for specialty care treatment†
Annual Deductible
PPO In-Network
- $50 per person
- $150 per family
PPO Out-of-Network **
- $50 per person
- $150 per family
DeltaCare USA (DHMO) ****
No annual deductible
Annual Maximum (Class I, II and III services)
PPO In-Network
$2,500
PPO Out-of-Network **
$2,500
DeltaCare USA (DHMO) ****
No annual maximum
Orthodontic Lifetime Maximum
PPO In-Network
$2,000 for adults and children
PPO Out-of-Network **
$2,000 for adults and children
DeltaCare USA (DHMO) ****
No lifetime orthodontic maximum
Claims
PPO In-Network
Delta Dental network dentists file claim forms and accept payment directly from Delta Dental
PPO Out-of-Network **
Non-Delta Dental dentists may require payment upfront and may require you to file your own claim for reimbursement
DeltaCare USA (DHMO) ****
No claim forms
Pay the listed copayment for covered services at the time of your visit
¹ DeltaCare USA is not available in MN and ND. In AK, CT, LA, ME, MS, MT, NH, NC, OK, SD, VT and WY, DeltaCare USA is provided as an open access plan. Members can obtain treatment from any licensed dentist and do not need to select a dentist upon enrolling in the plan. Because members can visit any dentist, no specialty care authorization is needed. Deductibles and maximums may apply for services provided by an out-of-network dentist.
* Subject to annual deductible
** 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.
*** Missing Tooth Limitation – Replacement of a missing tooth is covered under Class III benefits, however a 24-month coverage limitation exists. For replacement of a missing tooth within 24 months of enrollment, the plan pays at 30%, and you will pay 70%. For 25 months and beyond, the plan pays at 60%, and you will pay 40%.
**** DeltaCare USA plan: If you enroll in the DHMO option, you will be sent complete information on covered services, policy limitations and benefit exclusions for the DeltaCare USA plan in your area. If you wish to review that information in advance of your enrollment, please contact the Delta Dental Customer Service department at 844-883-4288 and request a copy.
† If a DeltaCare USA provider determines that a patient requires services from a specialist and there is no DeltaCare USA specialist within the lesser of 35 miles or one hour commuting time, the patient will be authorized to seek treatment from a PPO, Premier or non-network specialist.
Resources
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Delta Dental is a registered mark of Delta Dental Plans Association.