With Delta Dental Basic PPO, if you use a dentist from Delta’s PPO network you are reimbursed at a contracted amount based on usual and customary (U&C) fees. You also have the option of going to a dentist outside the network. When you go outside the network, you pay any difference between Delta’s U&C and the amount your dentist charges. This plan does not cover orthodontia or dental implants.
The Delta Dental Enhanced PPO allows you to choose a dentist in or out of the Delta network, but pays more when you stay in-network. This plan has a higher annual maximum benefit than Delta Dental Basic PPO does, and it covers orthodontia and dental implants. If you use a PPO network dentist your annual maximum benefit is $3,000, otherwise it is $1,500 for Premier or non-network dentists. Please note that if you use a PPO network dentist first and subsequently a Premier or non-network dentist the cost of your PPO provider services counts toward the $1,500 Premier or non-network annual maximum limit.
Delta Dental's standard payment practice for reimbursement of orthodontic services is to pay the lifetime maximum over two installments. The first coming when the initial claims is processed and the second 12 months later. Depending upon the date orthodontic services were received and the claim processed the second payment may not occur until the next plan year.
For more information on commonly covered services and your costs, see the dental plan comparison chart or view the individual summary plan descriptions for Delta Basic PPO and Delta Dental Enhanced PPO.