Your Dental Options
You can choose from two dental options: PPO Plan-Group 1207 or EPO Plan-Group 6719. You can also waive coverage.
The PPO and EPO options differ in:
- Annual Deductible (the amount you pay in a calendar year for items subject to a deductible, before the plan pays for covered expenses) - PPO Plan only
- Coinsurance (the percentage amount you "share payment responsibility" with the insurance company for services rendered) - PPO Plan only
- Calendar Year Maximum (the most the insurance company will pay for services on your behalf) - PPO Plan only
- Copays - EPO Plan only
- Out-of-Network Services
- Orthodontia coverage
- Employee's contribution (the portion of the premium you must pay)
Be sure to let your dentist's office know that claims should be filed with Delta Dental of Colorado. Delta Dental has operations in other states as well. If your claim is filed with Delta Dental in a state other than Colorado, it will not be paid in a timely manner, or could even be denied.
You will not receive an ID card from Delta Dental. To obtain a card, visit www.deltadentalco.com and select Member Login to access your existing account or, if new to Delta Dental, to create a New User Account. For instructions on creating a new account, please click HERE.
How the Dental Plans Work
PREVENTION FIRST! Preventative care on the PPO Plan will no longer apply to your calendar year maximum!
The two dental options are known as Preferred Provider Organization (uses both Delta's PPO and Premier Networks) and Exclusive Panel Option (EPO and uses Delta's PPO Network ONLY). A PPO is a group of dentists that have a signed agreement with Delta Dental to accept a reduced fee to provide services.
There are three types of dentists you may use:
- PPO Plan - Delta Dental PPO and Premier Dentists
- EPO Plan - Delta Dental PPO Dentists ONLY
- PPO Plan - Non participating Dentists
- EPO Plan - There are NO out-of-network benefits
The benefits of seeing an in-network dentist include:
- Reduced fees charged by the dentist, reducing costs
- PPO dentists submit claims directly to Delta Dental
- You are responsible only for the applicable deductible, coinsurance payments, copays (EPO Plan), and non-covered services
You have the option of seeing an out-of-network dentist on the PPO Plan only. You will be responsible for the difference between the non-participating Maximum Plan Allowance and the full fee charged by the dentist.
If you elect to see a dentist who is a contracted Delta Dental dentist you have the safety net of your claims being filed directly with Delta Dental and you still have a cost savings in that Delta Dental will pay based on the contract agreement with the Delta Dental dentist.
If you elect to see an out-of-network dentist who isn't a Delta Dental contracted dentist, also known as a non-participating dentist, the following is applicable:
- You may be responsible for payment in full to the dentist or for filing your claim with Delta Dental for reimbursement
- You are responsible for any difference between Delta Dental's payment and the dentist's charged fee
If you expect to have dental services that exceed $400, we recommend your dentist submit the treatment plan to Delta Dental for review before any work is begun. A pre-treatment estimate allows both you and your dentist to know exactly what is covered and what your plan will pay.
To find a participating dentist, log on to www.deltadental.com or call member services at 1-800-610-0201.