- 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.
- 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.
- How do I access the Delta Dental member connection?
- View the member connection flyer to find out how to register for the Member Connection. Click here to be taken to the Member Connection, where you can access benefits, eligibility, and claims information for your plan.
- Can I cancel my insurance plan mid-year?
- 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 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 benefit related information, you should contact Delta Dental customer service at (800) 323-1743, or email at CSI@deltadentalil.com.