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

Posted by on Feb 28, 2012 in Delta Dental | 0 comments

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