Getting the Most out of the Delta Dental PPO Plan

April, 2009

Beginning on January 1, 2009, the Southern California IBEW-NECA Health Plan - Active replaced the self-funded dental plan with a new dental PPO plan administered by Delta Dental of California. Changing to Delta Dental PPO provides access to the largest dental network in California and increases the maximum annual dental benefit from $2,000 to $2,500 when you use dentists who are part of the Delta Dental PPO network.

The Delta Dental PPO plan is different from the prior self-funded dental plan in some significant ways. One of the most significant differences is that there is no schedule you can look at to find out how much Delta Dental PPO will pay for any particular dental procedure. Delta Dental PPO contracts with participating dentists on an individual basis and their benefits are based on what the contract allows the Delta Dental PPO dentist to charge. If you go to a dentist who does not belong to the Delta Dental PPO network, then Delta’s allowance will be based on what they allow a PPO dentist in the same geographic area to charge.

What can you do to maximize your dental benefits and minimize any uncertainty about what your dental care will cost you?

There’s a simple solution:

First, advise your dentist you are covered by Delta Dental’s PPO plan and present your Delta Dental of California enrollment card. If your dentist belongs to the Delta Dental PPO network, you will automatically receive the highest benefit available under Delta Dental PPO’s plan and minimize your out-of-pocket costs for any dental care you receive.

Second, if your dentist determines that non-routine dental services that will cost more than $300 should be performed or that extensive dental work involving crowns or bridges is necessary, ask your dentist to request a predetermination from Delta Dental PPO. Delta Dental PPO will provide both you and your dentist with an estimate of the benefits they will pay under the Delta Dental PPO plan for the proposed services, if you are eligible and meet all of the requirements of your plan at the time the proposed dental treatment is completed. That way, you will know ahead of time what your dentist will charge for the services, what Delta Dental PPO will pay under the terms of the new PPO plan, and what you will have to pay out-of-pocket.

Remember, you can request a predetermination from Delta Dental PPO whether your dentist belongs to the Delta Dental PPO network or not. And, Delta Dental PPO provides the predetermination for free.

If you have any questions about your dental benefits under the Delta Dental PPO plan, call Delta Dental’s member services department at 800-765-6003. If you need to find a Delta Dental PPO provider in your area, go to Delta’s web site at deltadentalins.com. In the “Find A Dentist” menu, select “Delta Dental PPO” and then “search.” Enter your zip code, the distance you’re willing to travel and any other special requirements, like language preference.

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