Delta Dental Premier is a fee-for-service plan with a wide range of covered
services. When enrolled in a Premier plan, you have the freedom to see any dentist. But you save money if you choose
a dentist who participates in the Delta Dental Premier network. These dentists agree to accept Delta Dental's fee
schedule, which reduces your out-of-pocket costs. And, you can't be charged more than what Delta Dental allows for
services. You can be charged only for your deductible and coinsurance at the time of service.
You may select any licensed dentist for your dental care. But non-participating dentists may charge you more, in addition to deductibles
and coinsurance. The following chart gives you examples of cost, based on the dentist you choose:
Fee examples when you see your dentist for an exam, cleaning and full-mouth x-ray:
| |
|
Delta Dental
Premier Dentist |
Non-Participating
Dentist |
| A |
Fee Charged by Dentist |
$245 |
$245 |
| B |
Our Maximum Allowance |
$225 |
$191 |
| C |
Non Chargeable Amount |
$20 |
N/A |
| D |
% Allowance Paid by Delta Dental |
100% |
100% |
| E |
Delta Dental Pays (B x D= ) |
$225 |
$191 |
| F |
Member Pays: |
$0 |
$54 |
| |
|
Premier (B-E=) |
Non-Par (A-E=) |
In this example, you saved $54 by seeing a Delta Dental Premier dentist in comparison to the non-participating dentist.
*This example uses hypothetical fees and assumes that your annual deductible has been met.
|
