Delta Dental of Massachusetts

Delta Dental PPO Plus Premier – (Formally Blue Cross and Blue Shield Dental Blue)

Download Benefit Summary for Delta Dental PPO Plus Premier – (Formally Dental Blue)

Delta Dental PPO – (Formerly Blue Cross and Blue Shield Dental Blue PPO)

Download Benefit Summary Delta Dental PPO – (Formerly Dental Blue PPO)

How the Delta Dental PPO Plus Premier Works

The Delta Dental PPO Plus Premier program combines two of Delta’s dental networks – Delta PPO and Delta Premier network– giving you access to dentist that participate in both.

When you need dental services, you will be able to select a dentist from either the Delta Premier or the Delta PPO network of dentists. However, your out-of-pocket expenses will be different, depending on which network you select.

  • The Delta Premier network is a large network of dentists, with approximately 96% of dentist in Massachusetts. Savings are created through Delta-negotiated dentists’ fees.

  • The Delta PPO network is a smaller network of dentists who have agreed to fees that are up to 25% -30% less than what dentists normally charge. Approximately 20% of dentist who participate with Delta Premier in Massachusetts also participate with Delta PPO. Most often, the Delta PPO network will result in greater out-of-pocket savings for you, as compared to the Delta Premier network.

  • Members or eligible dependents who receive services from a dentist who does not contract with Delta Dental will still be eligible for coverage, but without the benefit of the Delta discount. You will be balanced billed for the difference between the dentist’s charge and the maximum payment allowed by the Fund.

To verify if your dentist is part of the Delta Dental PPO Plus Premier, refer to the Directory of Participating Providers available thorough Delta Dental or Delta Dental’s website www.deltadentalma.com. You can also call Delta Dental Customer Service department at (800) 872-0500. When choosing a participating provider, keep in mind that the deepest discounts will be received with a Delta PPO provider.

How the Delta Dental PPO Works

  • The Delta Dental PPO network of dentist has agreed to fees that are up to 25%-30% less than what dentists normally charge.

  • When you need dental service, you will be able to select a dentist from one of the 2600 Delta Dental PPO network.

  • To find if your dentist is part of the Delta Dental PPO network you can contact Delta Dental directly at 1-800- 872-0500 or go to the Delta web site at www.deltadentalma.com,

  • Members or eligible dependents who receive services from a dentist who does not contract with Delta Dental PPO will still be eligible for coverage, but with payments based on 80% of the network coverage levels for covered services.

MAXIMUM PAYMENT

The maximum payment each calendar year is $1,500 for each insured person, excluding orthodontia. Reimbursement for orthodontia procedures is up to 50% of the orthodontist’s charges to a lifetime maximum of $2,00 for each insured person.

PRE-TREATMENT ESTIMATES

If your dentist expect that dental treatment will involve a series of covered services, he or she should file a copy of the treatment plan with Delta Dental BEFORE these services are rendered to you or your dependent. A treatment plan is a detailed description of the procedures that the dentist plans to perform and includes an estimate of the charges for each service. Pre-treatment estimates are recommended for any services that are $300 or more, but are not mandatory.

Upon receipt of the treatment plan Delta Dental will notify you and your dentist about the maximum extent of your benefits for the services reported. If your dentist does not file a treatment plan for a pre-treatment estimate, Delta Dental will decide the extent of your benefit based on a review of those services using standards that are generally considered as accepted dental practices.