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Delta Dental PPO and Premier – How The Dual Network Works

Nov 28, 2022, 3 Minute Read

Delta Dental PPO™ plan members have access to two Delta Dental networks – Delta Dental PPO and Delta Dental Premier®. Together, they make up the largest network of dentists in the nation, according to Zelis Network360®. In fact, four out of five dentists in the United States are Delta Dental network dentists. The main difference between the two networks is the amount members can save.

Member Savings

There are three options: PPO, Premier, and non-Delta Dental dentists. Members save the most when visiting a Delta Dental PPO dentist, a little less at a Premier dentist, and the least at a non-Delta Dental dentist.

Delta Dental PPO Network
With this large, high-quality and reliable network of dentists, members don’t need to carry paper ID cards or submit claims, since Delta Dental works directly with dentists to manage identification and claims.

By visiting a dentist in the PPO network, members pay less out-of-pocket and make their plan maximum go farther. PPO dentists have agreed to reduced fees, which means added savings and no unexpected out-of-pocket costs.

But members don’t have to sacrifice plan savings if their dentist isn’t in the PPO network.

Delta Dental Premier Network
By visiting a dentist in the Premier network, members can expect the same advantages of a high-quality network and easy access, but with more limited out-of-pocket savings.

Delta Dental Premier dentists have also agreed to discounted fees, as part of their contract with Delta Dental. Premier fees are typically higher than Delta Dental PPO fees. Like with PPO dentists, members won’t pay more than their expected share — so there are no surprise bills.

Non-Delta Dental dentists can set any price they wish.

Plan Configuration Can Encourage PPO Utilization

To encourage in-network visits long term, it’s best to build incentives into plan designs that encourage visiting in-network dentists. Groups may have the following options:

• Reward employees who stay in network with a higher maximum and lower (or no) deductible for in-network visits.
• Cover services at a higher benefit level for in-network care. For example, a plan with a benefit network differential might cover diagnostic and preventive services at 100% at PPO dentists, 90% at Premier dentists and 80% at non-Delta Dental dentists. This makes it clear to members that PPO dentists offer the greatest savings.
• Lower out-of-network reimbursement to encourage PPO and Premier network usage and potentially lower the plan’s cost.

Reimbursements

The amount the plan bases its payment on is the reimbursement, also known as the maximum plan allowance. This is separate from the percentage at which certain services are covered.

Under a Delta Dental PPO plan, PPO dentists are reimbursed at PPO fees and Premier dentists are reimbursed at either Premier or PPO fees. How Premier dentists are reimbursed under a PPO plan is up to the plan’s benefits administrator, but there are advantages to each of the two options:

• When choosing to reimburse Premier dentists at Premier fees, members enjoy the lowest out-of-pocket costs, but the plan pays more and may cost more overall.
• When choosing to reimburse Premier dentists at PPO fees, members face higher out-of-pocket expenses at Premier dentists, but the plan may cost less overall. This option also creates a greater incentive for members to visit a PPO dentist.

In-Network Dentists

With the Find a Dentist tool, members can check a dentist’s network by entering their own location and choosing their preferred network from the ‘Select a Network’ drop-down menu. Each dentist’s directory listing indicates which networks the dentist participates in.

With Delta Dental’s dual network, your clients and their employees can make informed choices about their care and costs, without sacrificing quality.

Contact us today for a Delta Dental quote.

Get a Quote

Resources

• Elevate Your Smile flyer.
• Get to Know The Delta Dental PPO and Delta Dental Premier Networks video.
• Delta Dental Small Business Program brochure.
• Delta Dental’s SBP plan comparison.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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