Delta Dental Premier/PPO (Combined) Plans
With these plans you are provided with a unique opportunity we call the
combined network or "plus Premier" feature. This feature allows you to select a dentist from either the Delta Dental PPO or the Delta
Dental Premier network with no balance-billing. These participating dentists
have agreed to accept our Plan Allowance as payment in full for your Covered Benefits.
This means that you pay your deductible and any co-insurance for Covered Benefits.
We pay the dentist directly, so you do not have to pay the whole bill up front and
wait for reimbursement.
Of course, you may select any licensed dentist to provide your
dental care. For Covered Benefits provided by non-participating dentists, our payment
is based on the Delta Dental PPO Plan Allowance. Non-participating dentists have
not agreed to accept our discounted PPO Plan Allowance as payment in full. This
means that in addition to what Delta Dental pays, you must pay any deductible and
co-insurance. In addition, for a non-participating dentist you must also pay the
difference between our non-participating dentist allowance and the charges submitted
by this dentist. Therefore, the amount you would owe a non-participating is typically
higher than if you chose a Delta Dental PPO or Delta Dental Premier Dentist. If
you go to a non-participating dentist, in most cases, we will pay you directly for
Covered Benefits unless an assignment of benefits is made with Delta Dental. We
pay PPO dentists directly, so you do not have to pay the whole bill up front and
wait for reimbursement.
