Delta Dental offers a variety of benefit plans to meet the needs of our employer groups and members. The plans are described below. Please contact a Professional Services staff member at 303-889-8677 or email us at Profservices@ddpco.com for additional details on the products and how you can participate in our networks.
Delta Dental Premier
The Delta Dental Premier plan offers an extensive listing of covered services. Members may choose any licensed dentist for treatment.
As a participating Delta Dental Premier dentist:
- You agree to file claims directly with Delta Dental.
- You accept the Delta Dental Maximum Plan Allowance (MPA) for procedures performed.
- Members are responsible only for the payment of their deductible, coinsurance and any non-covered services, up the approved amount for the procedure.
- You receive payments directly from Delta Dental.
- You are required to complete the Delta Dental Premier Participating Dentist Agreement.
Voluntary Dental (Gold and Platinum) Plans
A Feature of Delta Dental Premier
The Voluntary Dental Plans are the Delta Dental Premier plans designed to meet an employer's need to provide a comprehensive benefits package while reallocating costs.
With Voluntary Dental Plans:
- Employers can offer a dental benefit plan with little or no employer contribution required.
- Members elect to participate in, and pay for, their own dental coverage.
- Members may choose any licensed dentist for treatment.
- If members choose a Delta Dental Premier participating dentist, they are responsible only for the payment of their deductible, coinsurance and any non-covered procedures, up to the approved amount.
- Delta Dental pays the dentist directly.
- Members receiving treatment from a non-participating dentist may experience greater out of pocket cost than if a Delta Dental Premier dentist is chosen.
Delta Dental PPO
Members may choose any licensed dentist for treatment under the Delta Dental PPO, but will receive the highest level of benefits if they choose a Delta Dental PPO participating dentist.
As a participating Delta Dental PPO dentist:
- You agree to accept the Delta Dental PPO Schedule of Allowances as payment in full for services provided to PPO members.
- Members are responsible only for their deductible, coinsurance and any non-covered procedures, up to the approved amount.
- You agree to file claims directly with Delta Dental.
- You are required to complete the Delta Dental PPO Participating Dentist Agreement.
Exclusive Panel Option (EPO)
A Feature of Delta Dental PPO
The Exclusive Panel Option (EPO), a feature of the Delta Dental PPO, provides dental benefits to members who use a PPO dentist for their dental care. NO benefits are available when members receive treatment from a non-PPO dentist.
With EPO plans:
- Participating PPO dentists file claims directly with Delta Dental.
- There are no annual maximums or deductibles for most groups.
- Members are responsible for their copayments or coinsurance and any non-covered procedures, up to the approved amount for the procedure.
- Participating PPO dentists do not balance bill the member for amounts exceeding the approved amount for a procedure.
Maximum Allowable Charge (MAC) Plan
A Feature of Delta Dental PPO
Similar to the Delta Dental PPO product, a MAC plan provides reimbursement based on the Delta Dental PPO Schedule of Allowances, with the reimbursement to both in-network and out-of-network providers based on the PPO (MAC) fee.
With the MAC plan:
- There is no balance billing of any amount exceeding the approved amount for the procedure if a member sees an in-network PPO dentist.
- The member is responsible only for payment of their deductible, coinsurance and any non-covered procedures, up to the approved amount for the procedure.
- If a member sees a non-PPO dentist (Delta Dental Premier or non-participating), Delta Dental will reimburse based on the PPO Schedule of Allowances and dentists can charge the difference between their own fee* and the PPO (MAC) fee.
*The Delta Dental Premier participating dentist agrees not to balance bill the member for treatment charges that exceed the Delta Dental Maximum Plan Allowance (MPA).
Voluntary Maximum Allowable Charge (MAC) Plan
A Feature of the Delta Dental PPO
The Voluntary MAC Plan, a feature of the Delta Dental PPO plan, is another plan designed to meet an employer's need to provide a comprehensive benefits package while reallocating costs.
With the Voluntary MAC Plan:
- Little or no employer contribution is required.
- Each employee elects to participate in a dental plan and pays for their own coverage.
- Reimbursement is based on the Delta Dental PPO Schedule of Allowances.
- There is no balance billing in network.
- Members are responsible only for the payment of their deductible, coinsurance and any non-covered procedures, up to the approved amount.
- If a member sees a non-PPO dentist (Delta Dental Premier or non-participating), Delta Dental will reimburse based on the PPO Schedule of Allowances and dentists can charge the difference between their own fee* and the PPO (MAC) fee.
*The Delta Dental Premier participating dentist agrees not to balance bill the member for treatment charges that exceed the Delta Dental Maximum Plan Allowance (MPA).
Achieve Plan
As an initial introduction to the Colorado market, Delta Dental has launched the Achieve Plan as a pilot PPO program to small employer groups with between 2 – 99 employees.
These plans offer richer benefits for dental care provided by the Achieve dental network. The Achieve network is a subset of Delta Dental’s participating dentist network in which almost 500 general dentists were selected as a result of strong preventive practices, high customer satisfaction, and good long-term patient outcomes.
With the Achieve Plan:
- Members must use Achieve general dentists to receive benefits
- Members must use a PPO or Premier specialist to receive benefits
- Members receiving treatment from non-participating dentists do not receive benefits
- Members are responsible only for the payment of their deductible, coinsurance and any non-covered services, up to the approved amount for any procedure
- Achieve Plans are Colorado only
Delta Dental Patient Direct®, a discount plan for groups
Delta Dental Patient Direct, a Discount Plan for Groups, is a uniquely designed discount plan that will be offered to employer groups looking for a low-cost alternative to dental insurance. This plan is designed to encourage patients to get the dental care they need.
Delta Dental of Colorado formed a partnership that allows us to market a discount dental product to employer groups throughout Colorado. This discount plan utilizes a separate network of over 200 contracted dentists that members must use in order to receive discounts on certain procedures.
With the Delta Dental Patient Direct discount plan for groups, there are no deductibles, no waiting periods, no annual benefit maximums, and no claims to file. The Patient Direct Plan is a discount plan, not an insurance product.
Delta Dental Patient Direct®, a discount plan for individuals
Delta Dental Patient Direct is a discount product available to those individuals who would otherwise not have dental benefits. This is not an insurance product.
With Patient Direct:
- The membership fee is $99 for individuals and $120 for families (an unlimited number of dependents under age 19 included).
- You agree to accept the Delta Dental Patient Direct Schedule of Allowances as payment in full for performed procedures.
- Members pay their dentists directly.
- There are no claims to file, no frequency limitations, no deductibles or maximums.
- Your practice will be marketed to more than 1.5 million Coloradoans who have no access to employer-sponsored dental plans.
- To participate in Patient Direct, you need to complete the Delta Dental Patient Direct Participating Dentist Agreement.
Child Health Plan Plus (CHP+)
Delta Dental administers CHP+, Colorado's state health care plan for low-income children who do not qualify for Medicaid. Approximately 30,000 children 18 years of age and under are enrolled in this program.
With the CHP+ program:
- Members must see a participating CHP+ provider, a Delta Dental Premier provider, or a Delta Dental PPO provider, depending on the county in which they live.
- Members may be required to pay a small copayment for procedures listed on their benefit sheet.
- Reimbursement is based on the approved amount for each procedure.
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