Member Benefits

DELTA DENTAL PLAN OF MASSACHUSETTS
DELTA DENTAL PPO PLUS PREMIER

Delta Dental PPO Plus Premier is a comprehensive dental plan administered by Delta Dental Plan of Massachusetts.

2024 Delta Dental PPO Plus Premier Schedule 

How the Delta Dental PPO Plus Premier Program Works

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

When you need dental services, you will be able to select a dentist from either the Delta Dental Premier or the Delta Dental PPO network of dentists. Depending on which network you select, the payment for covered dental procedures may vary.

• The Delta Dental Premier network is a large network of dentists, with approximately 90% of dentists in Massachusetts. Savings are created through Delta-negotiated dentist fees.

• The Delta Dental PPO network is a smaller network of dentists who have agreed to fees that are up to 35%-45% less than what dentists normally charge. Approximately 30% of dentists who participate with Delta Premier in Massachusetts also participate with Delta Dental PPO. Most often, the Delta Dental PPO network will result in greater out-of-pocket savings for you, as compared to the Delta Dental 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 balance 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 network, simply visit www.deltadentalma.com to find a participating dentist in your area. 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 Dental PPO provider.

Maximum Payment

The maximum payment each calendar year is $1,052.00 for each insured person, excluding orthodontia. Reimbursement for orthodontia procedures is up to 50% of the orthodontist’s charges to a lifetime maximum of $2,000.00 for each insured person. Reimbursement of dental implants is $1,000.00 per calendar year

Pre-Treatment Estimates

If your dentist expects 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.

DO YOU PARTICIPATE IN A FLEXIBLE SPENDING PLAN?

A Flexible Spending Plan is a program that allows you to have a designated dollar amount of your paycheck put aside and held in an account until you need to use it for out-of-pocket healthcare expenses. The money is deducted before taxes are paid, allowing you to apply 100 percent of the money you earn and put aside toward eligible expenses. Out-of-pocket dental costs that are not covered by your dental insurance are an eligible expense under a Flexible Spending Plan. Some examples are: Crowns/Bridges, Dentures, Extractions, Fillings, Gum Treatment, Oral surgery, Orthodontia. For additional information call The Group Insurance Commission Health Care Spending Account Administrator at 1 (800) 745-9202 or visit the Group Insurance Commission web site at the link below.

www.mass.gov