Delta Dental PPO programs

Delta Dental PPO is one of our three contracted national network based programs. Participating dentists agree to fee schedules as payment in full. These Delta Dental PPO schedules provide deeper discounts that result in savings to the group and enrollees.

As with all of the Delta Dental networks, dentists agree to processing policies and are prohibited from billing and collecting fees in excess of the agreed upon schedule. This product allows enrolled patients to visit any dentist but offers additional savings when visiting a Delta Dental PPO network dentist.

Click here to see if your dentist is a participating provider with Delta Dental Insurance

DELTA DENTAL PPOSM DISCLOSURE:

In Alabama, Delta Dental PPOSM is underwritten and administered by Delta Dental Insurance Company.

PPOs (Preferred Provider Organizations)


PPOs (Preferred Provider Organizations) are dental networks that provide a listing of approved dentists who have agreed by contract to provide care at a reduced cost in exchange for greater access to patients and a streamlined reimbursement system. Dental PPO patients choose their dentist form the approved list, and are assured of the maximum cost of treatment. No specialist referrals are required. Each Alabama dental PPO has its own network and approved set of treatments. Dental PPOs available in Alabama include Alpha Insurance, Delta Dental, Aetna, and Humana. We have found Delta Dental provides the best value and selection of network providers than other dental insurance carriers in Alabama. Delta Dental only provides dental insurance to employers.

The word PPO might be familiar to you from the health insurance world, and it works much the same way in dental. See below for our break down of the basic elements of PPO dental insurance, including how PPO dental plans work and links to further reading.

Do you have PPO dental insurance plans?

Absolutely. We’re committed to bringing you access to the finest PPO networks in the country with carriers such as Delta Dental with over

How much does a PPO dental insurance plan cover?

PPO dental plans all quote coverage in terms of a percentage. The percent covered is the portion that your insurance company will pay your dentist for any services rendered.

What are the benefits of a PPO plan over some of your less expensive plans such as a DHMO?

It is true that PPO dental insurance carries a higher monthly premium than most of our other plan types. Often people choose to go with a PPO because it allows them to keep seeing a trusted dentist or because they prefer a dentist in the PPO network who is more conveniently located to the patient’s home. See more about dentist selection in the questions below.

Which dentists can I see?

The insurance carrier pays much more of your costs if you visit a dentist that is in their network. Most PPO dental plans will also reimburse you for visiting a dentist not in their network. Beware, however, because going out of network means two things for your wallet:

(1) The carrier pays a lower percentage of the procedure – so that cleaning that was covered at 80% in network might only be covered at 50% out of network.

(2) The actual price of the procedure that is being covered goes up! That’s right, an in network dentist actually charges less for a procedure than out of network. That is because those network dentists have a special deal with the insurance carrier. So, using that cleaning example again, going in network might have covered 80% of a $100 cleaning, but out of network means that cleaning now costs $150 AND the carrier is only covering 50%!

 

Full Coverage Dental Insurance


If you’re looking for full coverage dental insurance, you’ll be expecting your dental plan to cover a wide range of issues, from preventative procedures like cleanings to basic fillings and major services like crowns. Review the sections below to learn more about how you can use DentalInsuranceAL.com free quote submission for your Alabama group dental coverage needs.

What exactly does full coverage dental insurance mean?

In the world of dental insurance there are three tiers of coverage, preventive, minor, and major. Full coverage means that the plan reimburses procedures under all of those categories – everything from a cleaning to a root canal.

Annual Maximum

The yearly maximum is the total amount of money that a preferred provider organization or indemnity type of plan will contribute toward your care in a year (a “year” can either be based on your anniversary date when you joined the plan or the calendar year, depending on the insurance company). This means that, typically, on a minor or major procedure, after you meet the deductible, you will contribute part of the cost of the procedure and the insurance company will cover the remainder. The yearly maximum is the total amount the plan will contribute toward your care in a year, typically somewhere between $1000 and $2,000.

Here’s a quick example of how this system works with a $1,000.00 annual max: Let’s assume you have already met your deductible for the year and:

·         During a 12-month period of your insurance you undergo a dental procedure that costs $100 and—according to your plan—your share of the cost is $50. The plan will be responsible for $50.

·         And, let’s say that the yearly maximum on the plan you have is $1,000. As a result of the plan’s $50 contribution toward your first procedure, the plan will now contribute no more than $950 toward your dental bills for the remainder of that 12- month period.

·         Now, let’s say—for the sake of an example—that six months later you need a more expensive procedure done, say its cost is $1,000 and your share is $500. That leaves the plan to pay $500.

·         So far, in this example, the plan has paid $50+$500=$550 toward your care in that year. Because the yearly plan maximum was $1,000, the plan is now only responsible for contributing another $450 during the remainder of that 12-month period, and so on.

 

Where yearly maximums become a problem is when you have to have a lot of expensive work done within that 12-month period.

Using the example above, let’s say you have to have another $1,000 procedure done in that same year. Because the plan has paid $550 dollars to date, they will now only contribute $450 toward your care, leaving you with the balance, $50, to pay out of your own pocket.

It is therefore important to think about the condition of your teeth when deciding whether to opt for the plan with the higher, and more expensive, yearly maximum.

After the 12-month period is over, the amount the plan will pay moves back up to $1,000 again.

Keep in mind that the yearly maximum normally does include preventive care. So, if your dentist charges $60 for a cleaning, most plans normally pay the entire amount of that charge (unless you go to an out-of-network dentist in the case of a preferred provider organization) and the cleaning will affect your yearly maximum by the deduction of your preventative procedure.

If you’re interested in purchasing a dental health maintenance organization or discount plan, there are no yearly limits, simply use your plan as much as you need.

Always read the details of the plan you’re interested in before you buy.If you’re shopping for a preferred provider organization or indemnity plan should you purchase one with a higher yearly maximum?

If you want the flexibility of a preferred provider organization or indemnity plan and you anticipate the need for a lot of expensive dental work, then yes, choose a plan with a higher yearly maximum. But keep in mind that even if you have an unexpected, expensive procedure, a $1,000.00 yearly maximum buys you a lot of dental care. If you normally just have one major procedure done a year it should fall under that smaller yearly maximum amount—in other words, the less expensive preferred provider organization or indemnity plan, with a lower yearly plan maximum, would pay off since the premium is lower each month for a lower annual maximum.

When does it pay to buy the plan with the higher yearly plan maximum? It pays when you must us an out-of-network dentist for a lot of dental work done in a very short period of time.

Here’s an example:

Let’s say your company is in a rural area of the country and you’re going to have to use an out-of-network dentist for your care.

·         You’ve narrowed your plan choices down to two PPO plans. One plan is $30 a month and the other plan is $40 a month. The only difference is in the yearly plan maximums.

So the question is, is it worth it to pay the extra $120 a year in premium so the employees have a greater benefit at time of service?

·         Let’s say that you’ve been in the plan awhile and you’ve been seeing your dentist twice a year for preventive care and check-ups. Because you’re using an out of network dentist, the plan pays 80% of those costs.

·         Then, let’s say for the sake of example, lots of problems suddenly pop up with your teeth—all in the same year:

·         First, early in the year you need a simple filling,

·         then your wisdom teeth need to come out but two of them are impacted,

·         finally, you damage a tooth and need a root canal and a crown.

·         Below is an item-by-item breakdown of what you would have to pay for each of those procedures under two different plans.

Notice that by the time you get your crown, under Option A, you’ve completely exceeded your plan maximum and you would have to pay for the crown completely out of your own pocket. While under Option B, you are still under the plan maximum amount and your crown will cost you much less. As a rule of thumb through your employer plan your premium is pre taxed so your out of pocket at the provider is with after tax dollars. Another words, your better off paying more pre-taxed so that your out of pocket is less at time of service when your using your after tax dollars.

(Keep in mind these prices are representative of the industry as a whole—your costs will vary.):

   

 

 

Preferred Provider Organization

Option A

Preferred Provider Organization

Option B

Plan Maximum

$1,000

$2,000

Monthly Premium/

12-month total

$30

$360

$40

$480

Two cleanings/checkups

Avg. Cost = $180

 

You Pay: $0  Plan Pays: $180

 

You Pay: $0   Plan Pays: $180

One filling:

Avg. Cost = $150 Ded(50)

 

You Pay: $50  Plan Pays: $100

 

You Pay: $50  Plan Pays: $100

Two, Simple Wisdom teeth

extractions.

Avg. Cost = $300

 

 

You Pay: $60  Plan Pays: $240

 

 

You Pay: $60  Plan Pays: $240

Two Impacted

Wisdom teeth extractions

Avg. cost = $820

 

 

You Pay: $340 Plan Pays: $480

 

 

You Pay: $164  Plan Pays: $657

One Root Canal:

Avg. Cost $1,100

 

You Pay: $1100  Plan Pays: $0

 

You Pay: $ 497 Plan Pays: $824

One Crown:

Avg. Cost = $1160

 

You Pay: $1,160  Plan Pays: $0

 

You Pay: $1160 Plan Pays:$0

Your total

out-of-pocket costs

 

$3070

 

$2411

Savings

$640

$1299

 

As you can see, it takes a lot of dental work in one year and some fairly specific circumstances before the more expensive preferred provider organization saves you a significant amount of money. The decision comes down to your tolerance for risk. If you don’t want to use your savings, and if you can foresee a scenario in which you might need a lot of dental work in the same year, you may be more comfortable purchasing a plan that has a higher yearly maximum. Either way you are always better off paying more pre-tax for premiums and less with your after tax dollars when you need services. In the example above it is almost a 100% savings by paying $10 more per month pre taxed.

Dental Insurance With No Waiting Periods


If you’re in a hurry to get some coverage because of an urgent dental issue or a painful situation and you need dental insurance right now, then you’ve come to the right place. DentalInsuranceAL.com  has plenty of plans with no waiting periods. Click the Get a Quote above to find a plan that meets your Alabama employer needs.

 

PPO Dental Insurance

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