PPO (Preferred Provider Organization) providers participate in the network thereby agreeing to accept contracted fees as payment in full rather than their usual fee for patients. When you visit a PPO provider, you typically pay a certain percentage of the reduced rate (called coinsurance) and the plan pays the rest.
A Dental Health Maintenance Organization (DHMO) plan requires you to choose one dentist or facility to coordinate all of your oral health needs. If you need to see a specialist your primary care dentist will provide a referral. A DHMO plan doesn’t have any deductibles or maximums and you pay a fixed dollar amount for any treatment (a “copayment”). However, if you visit a dentist outside of the network, you will be responsible for the entire bill.
An annual maximum is the maximum dollar amount a benefit plan will pay toward the cost of care within a specific benefit period, usually a calendar year.
The portion of the cost of your treatment that you are required to pay.
A specific dollar amount that you must pay before the plan begins to cover your expenses.
This is a document you receive from your insurance carrier after you visit the provider. It is not a bill, but rather an explanation of what procedures were performed and what was covered by your plan. Though EOBs vary, they should include the provider’s fee, the portion your insurer paid and any amount you may owe (such as deductible, coinsurance or non-covered services). It should also include an update on how much of your annual maximum has been used and the amount you’ve paid toward your deductible.
A qualifying life event includes a change in marital status (marriage or divorce), the birth of a child, adoption of a child, or loss of other coverage. If you have had a qualifying life event, please contact the Benefit Partners Group Support Team at (847) 247-8811. You can enroll under a qualifying life event up to 60 days after such an event. If you miss that window, you will have to wait for the next available open enrollment period.
If you have enrollment, payment, or billing questions, please contact Benefit Partners Group at (847) 247-8811. If you are already enrolled and have questions about claims or other benefit related information, you should contact Delta Dental customer service at (800) 323-1743, or email CSI@deltadentalil.com. For questions related to Beam Dental and VSP, please contact the Beam Support Team at (800) 648-1179 or email email@example.com.