PPO

How Does Delta Dental PPO Insurance Work?
 

Your Delta Dental PPO insurance plan helps protect you from out-of-pocket costs for dental treatment. It is an investment in your oral health.

In return for your monthly premium, Delta Dental pays 100% of your diagnostic and preventive treatment.

Delta Dental will also pay a percentage of your fees for more extensive treatment based on this chart. The remaining percentage is your “copayment.”

You are also responsible for paying the first $50 for dental treatment for each covered person each year. This is known as your “annual deductible.”
 
Class of Benefits Delta Dental
PPO Will Pay
Class I: Diagnostic & Preventive
Examples: Oral evaluation, cleaning and polishing, bite-wing and periapical X-rays
100%
Class II: Basic Services*
Examples: Fillings, stainless steel crowns (children), endodontics, oral surgery
80%
Class III: Major Services*
Examples: Bridges, crowns, dentures, partials, implants
50%
Class IV: Orthodontic Services
(Max. Lifetime Benefit $1,500 per child)
50%
* Subject to annual $50 deductible (per person)
Annual Max. Benefit is $1,500 per person for Classes I, II and III.
 

How Does the Delta Dental PPO Network Maximize Savings?
 

Delta Dental PPO insurance saves you money because we contract with dentists who agree to a prenegotiated, discounted schedule of fees for our members.

All Delta Dental PPO network dentists accept our prenegotiated fees for service as payment in full, so you will not be balance-billed for any charges above those fees. This limits your out-of-pocket costs and maximizes your savings.

Delta Dental PPO insurance also offers secondary protection via the Delta Dental Premier network, but the maximum allowable charges are a little higher and will result in balance-billing and slightly higher out-of-pocket expenses for Delta Dental Premier members. Savings are greater when utilizing a Delta Dental PPO provider.
 
 
  Delta Dental
PPO
Delta Dental
Premier
Other/Not
Delta Dental
Usual Fee $100 $100 $100
Network MAC* $70 $70 N/A
Maximum Network Charge $70 $85 N/A
Plan Pays $56 $56 $56
Member Pays $14 $29 $44
* Maximum Allowable Charge (MAC), based upon network agreement.
Above illustration is for Class II services paid at 80% MAC, after deductible has been met.
Non-Network: Member pays the difference between PPO Maximum Allowable Charge and the dentist’s submited fee.
Note: Non-Delta Dental participating dentists are not bound by our fee schedules, but Delta Dental will pay any licensed dentist the Delta Dental PPO fees, and you are responsible for any remaining expenses.