Benefits Guide

Dental Network Savings

Both the Basic and Comprehensive Dental options are Preferred Provider Organization (PPO) plans administered by Delta Dental of Kansas. Delta Dental offers an extensive two-tier nation-wide network of providers – the Delta Dental Premier Network and the Delta Dental PPO Network. The level of eligible charges (based on network discount) will vary depending on whether you use a network provider and/or the network in which your provider participates.

Delta Dental Premier Network

Larger Network – 118,000 dentists in 163,000 offices
Delta Premier Discounts
No Balance Billing
No Paperwork

Delta Dental PPO Network

Smaller Network – 57,000 dentists in 88,000 offices
Deepest Discounts
No Balance Billing
No Paperwork

Example of Preventive Payment (Not subject to deductible)
Cleaning, Bitewing X-rays and Exam	Premier Network	PPO Network	Out-of-Network
Dentist’s Charge	$115	$115	$115
Delta’s Maximum Allowance (MPA)*	$108	$91	$82
Plan Pays 100% of MPA	$108	$91	$82
Patient Coinsurance = 0% of MPA	$0	$0	$0
Additional Amount Provider Can Charge (balance bill)	$0	$0	$33
Total Patient Charge	$0	$0	$33

Example of Major Procedure (Assume deductible has been met)
Crown	Premier Network	PPO Network	Out-of-Network
Dentist’s Charge	$725	$725	$725
Delta’s Maximum Allowance (MPA)*	$700	$616	$525
Plan Pays 50% of MPA	$350	$308	$262.50
Patient Coinsurance = 50% of MPA	$350	$308	$262.50
Additional Amount Provider Can Charge (balance bill)	$0	$0	$200
Total Patient Charge	$350	$308	$462.50

Above charges shown for illustrative purpose only. Your actual charges may vary.

* Maximum Allowable Charges (MPA) for a covered procedure means the fee established by Delta Dental. Delta develops the MPA from a number of sources, including but not limited to contract with dentists, input from dental consultants, the billed charges for the same procedures by dentists in that state, and other pertinent information. The MPA for in-network procedures ranges between approximately 70-80% of retail cost. The MPA for out-of network procedures ranges between 50-60% of retail cost. Other insurance companies or your dental provider may refer to this as “reasonable and customary” or R&C maximums. In addition, if a Delta Dental provider is used, the contract between the dentist and Delta Dental does not allow the dentist to bill you for the charges over the MPA (balance billing). However, using an out-of-network provider will put more of the cost on the participant because of the lower MPA and balance billing.