Dental Network Savings
Both the Basic and Comprehensive Dental options are Preferred Provider Organization (PPO) plans administered by Delta Dental of Kansas. Delta Dental offers an extensive two-tier nation-wide network of providers – the Delta Dental Premier Network and the Delta Dental PPO Network. The level of eligible charges (based on network discount) will vary depending on whether you use a network provider and/or the network in which your provider participates.
 
Delta Dental Premier Network
  • Larger Network – 118,000 dentists in 163,000 offices
  • Delta Premier Discounts
  • No Balance Billing
  • No Paperwork
Delta Dental PPO Network
  • Smaller Network – 57,000 dentists in 88,000 offices
  • Deepest Discounts
  • No Balance Billing
  • No Paperwork

Example of Preventive Payment (Not subject to deductible)

Cleaning, Bitewing X-rays and Exam

Premier
Network

PPO
Network

Out-of-Network

Dentist’s Charge

$115

$115

$115

Delta’s Maximum Allowance (MPA)*

$108

$91

$82

Plan Pays 100% of MPA

$108

$91

$82

Patient Coinsurance = 0% of MPA

$0

$0

$0

Additional Amount Provider Can Charge (balance bill)

$0

$0

$33

Total Patient Charge

$0

$0

$33
 

Example of Major Procedure (Assume deductible has been met)

Crown

Premier
Network

PPO
Network

Out-of-Network

Dentist’s Charge

$725

$725

$725

Delta’s Maximum Allowance (MPA)*

$700

$616

$525

Plan Pays 50% of MPA

$350

$308

$262.50

Patient Coinsurance = 50% of MPA

$350

$308

$262.50

Additional Amount Provider Can Charge (balance bill)

$0

$0

$200

Total Patient Charge

$350

$308

$462.50
 
* Maximum Allowable Charges (MPA) for a covered procedure means the fee established by Delta Dental. Delta develops the MPA from a number of sources, including but not limited to contract with dentists, input from dental consultants, the billed charges for the same procedures by dentists in that state, and other pertinent information. The MPA for in-network procedures ranges between approximately 70-80% of retail cost. The MPA for out-of network procedures ranges between 50-60% of retail cost. Other insurance companies or your dental provider may refer to this as “reasonable and customary” or R&C maximums. In addition, if a Delta Dental provider is used, the contract between the dentist and Delta Dental does not allow the dentist to bill you for the charges over the MPA (balance billing). However, using an out-of-network provider will put more of the cost on the participant because of the lower MPA and balance billing.