What is the difference between a PPO plan and a DHMO plan?
A Dental PPO (Preferred Provider Organization) plan offers a network feature. PPO dentists 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 dentist, you typically pay a certain percentage of the reduced rate (called coinsurance) and the plan pays the rest. Preventive and diagnostic services are covered at 100%.
A Dental Health Maintenance Organization (DHMO) plan requires you to choose one dentist or dental facility to coordinate all of your oral health needs. If you need to see a specialist, your primary care dentist will refer you. A DHMO plan doesn't have any deductibles or maximums. Instead, when you receive a dental service, you pay a fixed dollar amount for the treatment (a "copayment"). Often, preventive and diagnostic services have no copayment, so you pay nothing for these services. However, if you visit a dentist outside of the network, you will be responsible for the entire bill. Watch the video below for further details on Delta Dental's networks.
What is an annual maximum?
An annual maximum is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care within a specific benefit period, usually a calendar year. You can determine how much you've already used by checking your benefits and eligibility on the Member Connection.
What is coinsurance?
The portion of the cost of your dental treatment that you are required to pay. Most dental plans pay a pre-determined percentage of the cost, and you pay your coinsurance amount even after your deductible is reached.
What is a deductible?
A specific dollar amount that you must pay before the dental plan begins to cover your expenses.
What is an explanation of benefits or EOB?
This is a document you receive from Delta Dental after you visit the dentist. It is not a bill, but rather an explanation of what procedures were performed and what was covered by your dental plan. Though EOBs vary across Delta Dental member companies, they should include the dentist's fee, the portion Delta Dental 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.
What is considered a Qualifying Life Event?
A qualifying life event includes a change in marital status (marriage or divorce), a 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 (877) 247-8817. You can enroll under a qualifying life event up to 60 days after such event. If you miss that window, you will have to wait for the next available open enrollment period.
How do I access the Delta Dental member connection?
Once premium has been paid and your policy is in-force, there will be no cancellations or early termination of coverage. If a policy must be cancelled, the enrollee will be required to forfeit the premium paid. The enrollee will also be responsible for the entire payment of any balance due for treatment or service provided after cancellation or termination.
Who is Benefit Partners Group?
Benefit Partners Group administers the enrollment and payment process for the dental and vision plans. If you have any questions, please contact the Benefit Partners Group support team toll-free at (877) 247-8817.
Who do I contact with questions about enrollment, benefits or claims?
If you have enrollment, payment, or billing questions, please contact Benefit Partners Group toll-free at (877) 247-8817. 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 them at CSI@deltadentalil.com.