Delta Dental of Colorado | Members | Understanding Your Benefit Plan |PPO Plans

Delta Dental PPO Plans^*

The Delta Dental PPO Plan emphasizes choice by helping you save on the cost of your dental care. The PPO plan has a smaller network of dentists than the traditional Delta Dental Premier plan, but you'll receive greater coverage at more affordable prices. Just choose a dentist who participates in the Delta Dental PPO network, and you will receive the greatest level of savings on your out-of-pocket costs.

How does it work? PPO dentists have agreed to accept a discount as payment in full for covered procedures. You pay only your deductible and co-insurance. We pay PPO dentists directly, so you do not have to pay the whole bill up front and wait for reimbursement.

Here's an example of your potential costs for an exam, cleaning and full mouth x-ray, based on the dentist you choose:

		In-Network	Out-of-Network
		Delta Dental PPO Dentist	Delta Dental Premier Dentist	Non-Participating Dentist
A	Fee Charged by Dentist	$245	$245	$245
B	Our Maximum Allowance	$157	$225	$191
C	Non Chargeable Amount	$88	$20	N/A
D	% Allowance Paid by Delta Dental	100%	80%	80%
E	Delta Dental Pays (B x D= )	$157	$180	$152.80
F	Member Pays:	$0	$45	$92.20
		PPO/Premier (B-E)		Non-Par (A-E)

In this example, you saved $92.20 by seeing a PPO dentist. If you saw a Premier dentist, you still saved $47.20 ($92.20-$45) in comparison to the non-participating dentist.

^*This example uses hypothetical fees, assumes you are enrolled in a standard PPO Plan and you've met your annual deductible.

Delta Dental MAC Plans^*

Under the Delta Dental PPO plan with the MAC option, you may visit any dentist of your choice. There are three levels of dentists to choose from:

PPO participating dentist
Premier participating dentist (Non-PPO)
Non-Participating dentist (Non-PPO)

PPO Participating Dentist

The advantages of seeing a PPO dentist include:

Payment is based upon the PPO Dentist's discounted fee, or the fee actually charged - whatever is less.
Dentists submit claims directly to Delta Dental.
You are only responsible for any applicable deductible and coinsurance.
You can't be charged more than the PPO discounted fee the dentist agrees to accept.
Payment is made directly to the dentist.

Premier Participating Dentist (Non-PPO)

If you see a Premier dentist:

Dentists submit claim forms directly to Delta Dental.
You are responsible only for applicable deductible and coinsurance.
Payment is made directly to the dentist, up to the PPO discounted fee.
You can't be charged more than the Delta Dental Premier Maximum Plan Allowance (MPA).
You can't be charged more than the discounted fee the dentist agrees to accept.

Non-Participating Dentist (Non-PPO)

You have the option of seeing a non-participating dentist, but it will cost you more. In addition:

You may be responsible for payment in full to the dentist
You may have to file your claim with Delta Dental and wait for reimbursement
You pay the difference between the PPO discounted fee and the dentist's full fee.

With the MAC plan, here's an example of your potential costs if you see your dentist for an exam, cleaning and full mouth x-ray:

		In-Network	Out-of-Network
		Delta Dental PPO Dentist	Delta Dental Premier Dentist	Non-Participating Dentist
A	Fee Charged by Dentist	$245	$245	$245
B	Our Maximum Allowance (in this plan)	$157	$157	$157
C	Non Chargeable Amount	$88	$20	N/A
D	% Allowance Paid by Delta Dental	100%	100%	100%
E	Delta Dental Pays (B x D= )	$157	$157	$157
F	Member Pays:	$0	$68	$88
		PPO (B-E=)	Premier (A-C-E=)	Non-Par (A-E=)

In this example, you saved $88 by seeing a PPO dentist. If you saw a Premier dentist you still saved $20 in comparison to a non-participating dentist.

^*This example uses hypothetical fees and assumes your annual deductible has been met.

Delta Dental EPO Plans (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:

You must see a PPO Dentist to receive benefits.
You have access to more than 1,000 PPO dentists in Colorado.
PPO dentists submit claim forms directly to Delta Dental.
You pay only a copayment or coinsurance for those procedures listed on your Schedule of Benefits.
Non-covered services are billed to you at Delta Dental's discounted rate. You still save money even if the service is not covered under your plan.
Teeth whitening services and veneers are available at discounted rates - as non-covered services; you pay your dentist directly but still enjoy our discount.