Delta Dental PPO vs. Premier Network – What’s the Difference?

Network Information

  • PPO Network: 56% of dentist locations in California. PPO
    Dentists are considered In-network for all PPO, PPO Plus Premier, and
    Premier plans.
  • Premier Network: 90% of dentist locations in California. Delta
    Premier dentists are considered Out-of-Network for all PPO and PPO plus Premier plans, and are considered In-Network for Premier plans.

Dentist Reimbursement by Plan

  • PPO: Ina Classic or OPTIONS PPO plan, all dentists (PPO, Premier, and Non-contracted) are reimbursed at the lesser of the submitted charge or the PPO provider’s contracted fee.
  • PPO Plus Premier: If a member visits a PPO dentist, charges are reimbursed at
    the lesser of the submitted charge or PPO contracted fee.  If visiting a Premier dentist, charges are reimbursed at the lesser of the submitted charge or the Premier provider’s contracted fee.
    If a Delta Dental member goes to a Non-contracted dentist, charges are reimbursed at the lesser of the submitted charge OR the fee that satisfies a majority of dentists with the same training and geographical area.
  • Premier: If a member visits a PPO or Premier dentist, charges are reimbursed at the
    lesser of the submitted charge or the Premier provider’s contracted fee. Non-contracted dentist charges are reimbursed at the lesser of the submitted charge OR the fee that satisfies a majority of dentists with the same training and geographical area.

For more information, view the following:

New 2012 Summary of Benefits

Dental Procedures Demystified!

Fear of the dentist is not uncommon, in fact, about 50% of Americans admit some fear of dental procedures and about 10% are so frightened they actually avoid dental care.  It is far worse to avoid dental care, as dental pain and issues only get worse over time.  If you are afraid of dental treatments, you can talk to your dentist about sedatives designed to ease your anxiety and get you through dental procedures.

Once thing that can also help you is knowing more about the following common dental procedures:

Extractions

Teeth may need to be pulled in the event of dental pain or infection.  A certain amount of blood and pain is to be expected, so anesthesia can be used to reduce pain.  You can also use an MP3 player to deaden any sound.  Remember that any blood you se is mixed with your saliva, so it actually looks like you are bleeding more than you actually are!

Fillings

Cavities are small holes in teeth caused by germ-containing plaque, is treated by removing the surrounding area and filling the hole with materials to rebuild the tooth.  If cavities are not treated early, the bacteria will continue to eat away at the tooth, possibly resulting in a need for a root canal.  One way to lessen fear of the drilling and filling is to bring an MP3 player or similar device to listen to music while your dentist is working.

Root Canal

During a root canal, damaged tissue is cleaned out from inside a tooth. It’s a long procedure (sometimes lasting about two hours), but it can save your tooth. You can also bring along an MP3 player or you can break the treatment down into more manageable time periods.

X-Rays

X rays are designed to help your dentist find little problems before they become worse.  It can become a problem is you have a strong gag reflex or fear of radiation exposure.   Your dentist can use a little topical anesthesia to help control your gag reflex during this short dental procedure. It also may help to remember that the actual radiation exposure from dental X-rays is relatively minimal compared with the radiation exposure you get naturally each day.

Crowns

Crowns are used to protect a worn-out or weakened tooth.  The worst part of the procedure is the gag-inducing mold made of your tooth to shape the crown.  One way to alleviate this problem is to sit upright and use a faster-setting mold.

Dental Implants

Implants are used to replace missing teeth. They look natural and are stable as they are molded to your bone below your gums.  If you are afraid you can consider anesthesia.

Do Dental and Vision Plans Have to Cover Dependents to Age 26?

According to the Department of Health and Human Services (HHS)  the Department’s position that if benefits are “excepted  benefits” under HIPAA, the PPACA’s group health plan mandates and insurance  market reform requirements (e.g., no lifetime dollar limits on essential  health benefits, only “restricted” annual dollar limits on essential health benefits prior to 2014, no annual dollar limits on essential health benefits in 2014 and beyond, extended plan eligibility for adult children up to age 26, no waiting periods in excess of 90 days [effective 2014], insured health plan nondiscrimination rules, new internal claims and appeals/external review  processes) do not apply. 
 
A dental or vision benefit plan is a HIPAA-excepted benefit if it is:

 *Provided under a separate policy, certificate or contract of insurance (for insured plans)

 * Is otherwise not an integral part of the health care plan.
 For dental or vision benefits to be considered not an integral part of the plan (whether insured or self-insured), participants must have a right not to  receive the coverage and, if they do elect to receive the coverage, must pay
an additional premium  Accordingly, if a plan provides its dental or vision benefits pursuant to a
separate election by a participant and the plan charges even a nominal employee contribution toward the coverage, the dental or vision benefits would constitute excepted benefits, and the PPACA group health plan mandates and insurance market reform provisions would not apply to that coverage.

To put this in “plain english”  If the dental and vision plans are provided by a separate carrier than the medical and if an employee can make a separate election and premium payment for the dental and vision without having to have these benefits mirror the medical,  then the carrier does not have to offer dependent benefits to age 26.  Many dental and vison carriers are offering to continue benefits to age 26 as a courtesy, please check with the carrier to determine their position.

Is Dental Insurance All That Important?

Today I am writing to you through a pain pill induced haze.  Much better than the way I felt over the weekend, when tooth #30 finally gave out once again and decided to die in a very dramatic way – an abscess.  People say that a toothache is the kind of pain that “you wouldn’t wish on an enemy”.  I would.  But only if they were really, really bad. 

But I digress.  I used to think that the only benefit to dental insurance is the discounts provided by either the access to the PPO  network  or by the selection of an HMO dentist.  This still is true, the discounts are worthwhile.  I now know that the $50 or so dollars I spend each month for dental coverage is far less that the amount I would have to pay on the full charges for the dental care I am now in process of receiving.  Since I still have my wisdom teeth (pun intentional), I will illustrate how having dental insurance will save me money on the bridge now being made to replace the teeth pulled or ground down yesterday. 

Monthy Cost of Dental Insurance $50

Annual Cost of Dental Insurance $600

Maximum Annaul Benefit $1,500

Full Charge for Bridge $1,500

PPO Discounted Charge $1,200

50% Patient Responsiblity (my cost) $600

The amount I will have to pay for the bridge is the same amount I will pay for my dental coverage for this year.  If I didn’t have the coverage I would be reponsible for the full cost of the bridge, or $1,500.  Almost as painful as the abscess.

So to answer the question, yes I do think dental insurance is important.  I think people dont realize the sense of having either dental insurance or auto insurance – both are considered as useless until something goes wrong. 

Yes I am feeling better now.  I am grateful I have insurance – and the pain pills!

Assurant recognized as high quality Dental-Life-Disabilty carrier

assurant dental insuranceEvery insurance carrier claims to be “Leading the Industry”. 

Just because a company “says” they lead the industry, doesn’t make it true, but when other Independent Organizations say that Assurant Employee Benefits . . . it is easy to understand they earned it! 

  • is “Significantly above the Industry Average for timeliness” (JHA Disability Broker Study, 2009)
  • is “A Model Carrier for the establishment of an online claims management system that enables us to better serve claimants”  (Celent, 2008)
  • has a Dental Claims Center that is “Recognized as a ‘Center of Excellence’ …an award that goes to the top 10 Percent of 20,000 call centers through measurements of efficiency and effectiveness” (Purdue University, 2006)
  •  ”Among True Group Carriers, AEB ranked #1 in Overall Satisfaction…in Providing Service that exceeds Expectations…In being Easy to do Business with…and in Percentage of Policyholders willing to recommend us” (LIMRA Plan Administrator Satisfaction Study, 2009)
  • is Significantly Higher than Average in Overall Experience”  (JHA Disability Broker Study, 2009)

“Eye” Can See If You Are Healthy

According to a recent study cited by Employee Benefit News, one unexpected benefit of a vision care program is that employees with vision benefits have eye exams more frequently than a standard health assessment or “physical.” Specifically, with an optimally-designed (but not necessarily costly) vision plan, more than half of  Americans with a vision care plan will see their eye doctor annually.  For those without a vision plan, less than 21% of Americans will get annual physicals.

What does that have to do with overall physical health? Plenty.

Eye exams play a crucial role in supporting overall health because the eyes provide the only non-invasive and clear view of blood vessels without puncturing skin.  

Because optometrists can (and do) look at blood vessels during an eye exam, they can help identify symptoms of – and manage – a variety of conditions that might not otherwise be detected until there are other symptoms.

In particular, an eye doctor can detect signs of more than 30 chronic diseases by seeing changes in blood vessels, as well as representative brain cells in the optic nerve.

By examining the eyes, an optometrist can often detect symptoms of chronic conditions such as hypertension, high cholesterol and diabetes. Indeed, in some cases, an eye exam can lead to the detection of a diabetic condition up to seven years sooner than with standard testing.