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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.
Delta Dental Premier
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.
Achieve Plan
Delta Dental of Colorado recently unveiled its new Achieve Plan. This innovative plan is designed to maximize the potential for good long-term oral health outcomes while also providing an affordable dental insurance product. Dental health research has shown that preventive practices can result in improved patient oral health outcomes along with a corresponding reduction in treatment needs. As an initial introduction to the Colorado market, Delta Dental is launching the Achieve Plan as a pilot program to 2-9 Small Group and 10-99 Enrolled True Group.
Our concept in designing the Achieve Plan was to select general dentists who emphasize effective preventive dental care. The key feature of the Achieve Plan is the dental network in which almost 500 general dentists were selected for inclusion based on data that reflects specific practices that have proven to result in better long-term oral health outcomes. These characteristics include:
- Strong preventive programs
- High levels of patient retention
- High patient satisfaction
- Moderate to conservative treatment patterns
- Beneficial outcomes such as longer retention of natural teeth
Delta Dental Patient Direct,® a Discount Plan for Groups
Delta Dental Patient Direct®, a Discount Plan for Groups, is a uniquely designed plan that allows groups to offer a discount plan as a standalone product or paired with an insurance product. The Patient Direct Plan is designed to allow total flexibility for groups and members – with two dental fee schedules to choose from. Members can save a significant percentage on certain dental procedures from participating dentists in the separate Delta Dental Patient Direct® dental network of over 550 dentists. The Patient Direct Plan is a discount plan, not an insurance product, that’s affordable, valuable, and easy to use with no maximums, no waiting periods, no annual deductibles, and no claims to file.
Voluntary Group Dental Plan
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.
2-9 Product Portfolio
Delta Dental offers eight plan designs for employer groups with two to nine employees.
From this page you can download our 2-9 proposal which
includes plan designs, rates and underwriting guidelines, as well as all of the necessary forms to sign up for group coverage.
The product portfolio includes two Delta Dental Premier options, two Delta Dental PPO options, and four new Achieve options.
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.
COBRA Administration
Delta Dental has the capabilities of administering the dental benefits for your COBRA participants. Employer groups can contract with Delta Dental to offer dental benefits only or to handle the administration and billing of COBRA.
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.
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