Brokers and Group Administrators:     For more information on a specific plan design, please contact your Delta Dental Account Executive or call (303) 741-9300, ext.3300.

Dentists:  For more information on how your participation in the Delta Dental Premier and Delta Dental PPO networks relates to a specific product, please call Professional Services at 303-889-8677
or 1-800-610-0201 ext. 677.

Delta Dental PPO

The Delta Dental PPO emphasizes choice, while helping members save money on their dental care when seeing a Delta Dental PPO dentist. With the PPO plan:

• Participating PPO dentists have agreed to accept a reduced fee to provide services.
• Members will receive benefits if they see a Delta Dental PPO dentist (in-network) or a non-PPO (Delta Dental Premier or non-participating dentist).
• Members who choose to see a non-PPO dentist may incur additional out-of-pocket expenses.

Under the Delta Dental PPO, there are different plan designs available for employers:

Exclusive Panel Option (EPO)
(for Colorado residents only)

The Exclusive Panel Option (EPO) provides a comprehensive benefit plan, using the Delta Dental PPO Dentist network. With the EPO Plan:

• Benefits are available only to Colorado residents.
• Dental care must be provided by a PPO dentist.
• PPO dentists file claims directly with Delta Dental and agree not to balance bill patients for additional services.

Passive PPO

With a Passive PPO:

• Benefits are paid at the same level - both in-network and out-of-network.
• Patients have access to any licensed dentist with the added benefit of the Delta Dental Premier network.
• Patients have no claim forms when accessing services from a participating dentist.
• Participating dentists (Delta Dental PPO or Delta Dental Premier) agree to accept reimbursement from Delta Dental.
• Patients may have additional out-of-pocket expenses if they choose a non-participating dentist.

Maximum Allowable Charge (MAC)

With a Maximum Allowable Charge (MAC) plan:

• Benefits are paid based on the PPO fee schedule.
• Patients may see any dentist, but will receive greater benefits with a participating Delta Dental PPO dentist.
• If patients see a Delta Dental Premier dentist, they are responsible for the difference between the allowed amount and the Delta Dental PPO fee - plus any deductible or coinsurance.
• Patients who see non-participating dentists may incur additional out-of-pocket expenses.

The Delta Dental Premier plan offers an extensive list of covered services. Members may choose any licensed dentist for treatment. With the Delta Dental Premier plan:

• Members are responsible only for the payment of their deductible, coinsurance and any non-covered services up to the approved amount for the procedure.
• Delta Dental Premier dentists file claims directly with Delta Dental and accept reimbursement in full.
• If members choose a non-participating dentist, reimbursement may be lower and they may have additional out-of-pocket expenses.

The Voluntary Group Dental plan is designed to meet an employer's need to provide a comprehensive benefits package while reallocating costs to the employee. The plan allows employers to offer a dental benefit plan and each employee may elect to participate.

There are two types of Voluntary products available through Delta Dental, either the Gold or Platinum option. Delta Dental offers various voluntary dental options using either the Delta Dental Premier or Delta Dental PPO network of dentists.

• Gold Option- The Gold option provides a comprehensive benefits plan that has waiting periods on some major services. Waiting periods must be met before benefits will be paid.
  
• Platinum Option- The Platinum option provides comprehensive benefits from the date of enrollment, but the benefit coverage level improves the longer the member is enrolled in the program.

Evidence Based Dentistry (EBD)

EBD is a new approach to designing dental benefits based on scientific evidence that points to an association between a person’s oral health and their overall health. Although the evidence is not yet definitive, Delta Dental believes so strongly in the association between oral and overall health that we’re offering enhanced preventive benefits to all of our dental plans for no additional cost.

Prevention First

With the Prevention First rider, diagnostic and preventive services do not count toward the annual benefit maximum. This features encourages members to visit the dentist for regular check ups by extending each members annual maximum. The cost of adding the Prevention First Dental option varies based on the current plan design and claims experience.

Administrative Service Contracts

Self-funded groups may contract with Delta Dental for administrative dental services and the use of Delta Dental's provider network. Self-funded employers pay administrative fees to Delta Dental for processing claims, the use of network dentists and for additional administrative services. Groups may use either the Delta Dental Premier or Delta Dental PPO network for self-funded contracts.

Retiree Dental

Delta Dental offers retiree products for groups with 100 or more employees in their active group. The retiree dental plan is voluntary and the retiree is responsible for the cost of the program. Retirees may choose from three options for themselves and all eligible dependents up to age 25. Custom designed retiree products are available for groups with 500 active enrolled retirees in an existing dental plan.

EyeMed Vision Products

Delta Dental has partnered with EyeMed Vision Care, the nation's largest vision carrier to offer risk, self-funded and voluntary vision quotes to our brokers and employer groups. EyeMed has the nation's largest vision network with a large number of independent optical offices and retail chains such as Lenscrafters, Pearl Vision, Sears Optical and Target Optical centers.

As a standard benefit, all Delta Dental of Colorado dental members receive a free discount vision product available through EyeMed participating providers.